HCV Infection Challenges
Increasing reported incidence of acute and chronic HCV infection among persons aged 20-39 years over the past decade affects the number of pregnant women with HCV infection and infants who are exposed to HCV at birth.1 CDC’s recommendations to screen pregnant women for HCV infection during each pregnancy may aid practitioners in identifying HCV-infected mothers, which can lead to treatment for the mother during the postpartum period, and identify infants who should receive testing at a pediatric visit. The risk of an HCV-infected mother transmitting infection to their infant is approximately 6% per pregnancy, but the risk is higher if the mother has a high viral load or is coinfected with HIV.2 There are currently no treatments approved for use in pregnancy to prevent transmission of HCV infection to infants.
CDC recommends screening pregnant women during each pregnancy, and testing 1) all perinatally exposed infants ages 2–6 months for hepatitis C virus (HCV) with a nucleic acid test (NAT) for detection of ribonucleic acid (RNA); 2) all perinatally exposed infants and children aged 7–17 months who have not previously been tested should receive NAT RNA; and 3) all perinatally exposed children 18 months and older who have not previously been tested should receive an HCV antibody test with reflex to NAT for HCV RNA when antibody is reactive. Additionally, new parents and/or clinicians should consult a health care provider with expertise in pediatric hepatitis C management whenever an infant or child has detectable HCV RNA.
No recommended curative treatments are FDA approved for pregnant women or young children (aged <3 years), but curative treatment is approved for older children (aged ≥3 years) and women who are not pregnant (which can be given before or after pregnancy).
More studies are needed on the safety and efficacy of curative HCV treatments for pregnant women and young children.
- Centers for Disease Control and Prevention. 2019 Viral Hepatitis Surveillance Report, Accessed December 10, 2021.
- Benova L, Mohamoud M, Calvert C et al. Vertical transmission of hepatitis C virus: systematic review and meta-analysis – PubMed (nih.gov)
- American Association for the Study of Liver Diseases (AASLD); Infectious Diseases Society of America (IDSA). HCV guidance: HCV in Children | HCV Guidance (hcvguidelines.org) Accessed December 10, 2021.
- American Academy of Pediatrics. Consideration for Testing for infectious Agents. Red Book: 2021-2024 Report of the Committee on Infectious Diseases. Elk Grove Village, IL.