Update on Pediatric HCV: Screening, Treatment, and Other Considerations
Vertical HCV infection is the most common route of transmission in children.
Of approximately 200 million people infected with hepatitis C virus (HCV) worldwide, children comprise 0.05% to 0.4% of individuals in developed countries and 2% to 5% in resource-limited regions.1 Vertical HCV infection is the most common route of transmission in children. Chronic infection occurs in an estimated 5% of children born to mothers with HCV, increasing the risk of cirrhosis and liver failure, along with impaired cognitive function and overall health.2
Adverse fetal outcomes such as fetal growth restriction and low birth weight have been linked to HCV infection during pregnancy.3 While universal HCV screening is not currently recommended, it is recommended for children born to HCV-infected mothers, especially because children with HCV infection are typically asymptomatic. However, a recent study found that only 16% of children born to HCV-infected mothers underwent testing, and the investigators called for improvements in screening practices in pregnant women and their children.2
To learn more about screening, treatment, and other considerations for pediatric HCV, Infectious Disease Advisor spoke with 2 experts: Wikrom Karnsakul, MD, associate professor of pediatrics at Johns Hopkins University School of Medicine in Baltimore, Maryland, and director of the Pediatric Liver Center in the division of pediatric gastroenterology, hepatology and nutrition at Johns Hopkins Children's Center in Baltimore, Maryland; and Catherine Chappell, MD, MsC, OB/GYN and assistant professor in the department of obstetrics, gynecology, and reproductive sciences at Magee-Womens Hospital of the University of Pennsylvania Medical Center in Philadelphia.
Dr Chappell: Further research into interventions to improve screening and detection of HCV in individuals at greatest risk for transmission, such as active intravenous drug users (IVDUs) and pregnant women. Then, further interventions to facilitate treatment in those groups will be most effective to prevent further transmission of HCV.
Currently there are no interventions that are proven to prevent perinatal transmission of HCV. OB/GYNs avoid artificial rupture of membranes and the use of fetal scalp electrodes, which may be associated with increased maternal-to-child blood exchange. Cesarean delivery before the onset of labor also does not reduce transmission of HCV, although this practice does reduce transmission of HIV. Administration of antibiotics to mothers is common to prevent perinatal transmission of bacteria (like group B strep) as well as viruses (HIV and herpes simplex virus). With the recent development of potent antivirals for HCV, we now have the tools to prevent perinatal transmission of HCV. Ledipasvir/sofosbuvir (Harvoni) is a one-pill-once-a-day medication used for 12 weeks that has a >95% cure rate outside of pregnancy. We are doing the first study of the use of ledipasvir and sofobuvir in pregnant women (ClinicalTrials.gov identifier: NCT02683005). Our hope is that this medication will not only cure the maternal HCV infection, but also prevent transmission to the infant.
Although recommended for all infants born to HCV-infected mothers, HCV screening occurs in only a small percentage of cases, preventing many patients from receiving timely treatment.
- Tovo PA, Calitri C, Scolfaro C, Gabiano C, Garazzino S. Vertically acquired hepatitis C virus infection: Correlates of transmission and disease progression. World J Gastroenterol. 2016;22(4):1382-1392.
- Kuncio DE, Newbern EC, Johnson CC, Viner KM. Failure to test and identify perinatally infected children born to hepatitis C virus-infected women. Clin Infect Dis. 2016;62(8):980-985.
- Hughes BL, Page CM, Kuller JA; Society for Maternal-Fetal Medicine (SMFM). Hepatitis C in pregnancy: screening, treatment, and management [published online August 4, 2017]. Am J Obstet Gynecol. doi:10.1016/j.ajog.2017.07.039
- Karnsakul W, Schwarz KB. Hepatitis B and C. Pediatr Clin North Am. 2017;64(3):641-658.
- Schwarz KB, Karnsakul W. Treatment of hepatitis C in children. Current Hepatology Reports. 2017;16(1):18-25.