A review of hepatitis C virus (Hepatitis C Virus) vertical

transmission: risks of transmission to infants born

to mothers with and without Hepatitis C Virus viraemia or human immunodeficiency

virus infection

International Journal of Epidemiology, Vol 27, 108-117, Copyright © 1998 by International

Epidemiological Association

ARTICLES

SL Thomas, ML Newell, CS Peckham, AE Ades and AJ Hall

Department of Epidemiology & Biostatistics, Institute of Child Health, London, UK.

BACKGROUND: Hepatitis C virus (Hepatitis C Virus) vertical transmission studies have reported conflicting findings, possibly due to differences in Hepatitis C Virus transmission risk factors among maternal populations, or to methodological differences.

METHODS: Systematic review of worldwide published and unpublished Hepatitis C Virus vertical transmission studies. Standardized diagnostic criteria were applied to minimize methodological differences, and transmission rates recalculated according to maternal Hepatitis C Virus viraemic and human immunodeficiency virus (HIV) infection status. RESULTS: In all, 976 eligible infants from 28 studies were followed up sufficiently for recalculation of transmission rates. Overall transmission rates were less than 10% in 8/12 studies of HIV negative mothers, compared with 2/7 studies comprising at least 50% HIV-coinfected mothers. Rates from 409 viraemic mothers in 15 studies ranged from 0% to 41%, being less than 10% from HIV negative mothers in 6/13 studies and from HIV positive mothers in 1/6 studies. Nine studies measured maternal viraemia levels, with only 2/30 transmitting mothers having <10(6) copies/ml of Hepatitis C Virus RNA. Eight transmissions were identified overall from non-viraemic mothers. Significant transmission rate variation remained after accounting for maternal viraemia and HIV coinfection, possibly due to differences in other vertical transmission risk factors, in frequencies of postnatal transmission, or residual differences in study methodologies

CONCLUSIONS: Overall, Hepatitis C Virus transmission is largely restricted to infants born to Hepatitis C Virus viraemic mothers, and low risks among most HIV negative mothers may be due to lower Hepatitis C Virus viraemia levels. International agreement on standardized diagnostic criteria for Hepatitis C Virus vertical transmission would facilitate pooling of individual findings, to allow more precise transmission estimates and further investigation of risk factors.

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