Paternoster D M, Santarossa C, Grella P, Palù G, Baldo V, Boccagni P, Floreani A
Department of Obstetrics and Gynecology, Institute of Hygiene, University of Padua, Italy.
Am J Gastroenterol. 2001 Sep;96(9):2751-4. doi: 10.1111/j.1572-0241.2001.04135.x.
The risk of hepatitis C virus (HCV) infection in the newborn is estimated to be around 5%, but becomes very high in the case of coinfection with HIV. One of the main factors associated with the vertical transmission of HCV is the viral load. Our objective was to investigate the behavior of HCV viral load during pregnancy in relation to HIV coinfection, liver enzymes, and vertical transmission.
Three thousand seven hundred forty-eight women seen consecutively in their first trimester of pregnancy were screened for HCV infection. Sixty-five were found to be anti-HCV+/HCV RNA+ and were followed up with clinical and serological assessment (i.e., transaminases and quantitative polymerase chain reaction [PCR] for viral load) in their second and third trimesters and 6 months after delivery. All were anti-HIV and hepatitis B surface antigen negative. HCV RNA was 12.0+/-19.9 x 10(6) copies/ml in the first trimester and 10.9+/-13.3 x 10(6) in the second, but increased to 19.5+/-25.1 x 10(6) in the third trimester. Six months after delivery the viral load returned to the baseline levels; the changes in viral load did not reach any statistical significance, however. Transaminases tended toward a reduction from the baseline during the second and third trimesters, and then an increase in both AST and ALT was recorded 6 months after delivery. However, when the group whose AST/ALT were found abnormal at the first test was considered, no significant changes were recorded during the follow-up. The overall rate of vertical transmission was 4.6
With HCV+ mothers monitoring transaminases during pregnancy is unnecessary, and testing liver enzymes at the beginning of pregnancy is sufficient. Qualitative PCR should be done once during the pregnancy, but any staging of the liver disease should be taken after delivery. Quantitative PCR testing is expensive and pointless. Any decision for elective cesarean section in HCV RNA+ mothers should be confirmed by other studies.
据估计，新生儿感染丙型肝炎病毒（HCV）的风险约为5%，但在合并感染HIV的情况下这一风险会变得非常高。与HCV垂直传播相关的主要因素之一是病毒载量。我们的目的是研究孕期HCV病毒载量与HIV合并感染、肝酶及垂直传播之间的关系。
对连续就诊的3748名孕早期妇女进行HCV感染筛查。65名妇女抗-HCV+/HCV RNA+，在孕中期、孕晚期及产后6个月进行临床和血清学评估（即转氨酶及病毒载量的定量聚合酶链反应[PCR]）。所有妇女抗-HIV及乙肝表面抗原均为阴性。孕早期HCV RNA为12.0±19.9×10⁶拷贝/毫升，孕中期为10.9±13.3×10⁶，而孕晚期增至19.5±25.1×10⁶。产后6个月病毒载量恢复至基线水平；然而，病毒载量的变化未达到任何统计学显著性。孕中期和孕晚期转氨酶较基线水平有下降趋势，产后6个月AST和ALT均升高。然而，当考虑首次检测时AST/ALT异常的组时，随访期间未记录到显著变化。垂直传播的总体发生率为4.6。
对于HCV阳性母亲，孕期监测转氨酶没有必要，在孕早期检测肝酶就足够了。孕期应进行一次定性PCR，但肝病分期应在产后进行。定量PCR检测昂贵且无意义。对于HCV RNA阳性母亲进行选择性剖宫产的任何决定都应通过其他研究予以证实。
