Population Health Sciences, University of Bristol Medical School, Bristol, United Kingdom.
Medical Research Council Clinical Trials Unit, University College London, London, United Kingdom.
Clin Infect Dis. 2023 Mar 4;76(5):905-912. doi: 10.1093/cid/ciac270.
It is widely accepted that the risk of hepatitis C virus (HCV) vertical transmission (VT) is 5%-6% in monoinfected women, and that 25%-40% of HCV infection clears spontaneously within 5 years. However, there is no consensus on how VT rates should be estimated, and there is a lack of information on VT rates "net" of clearance.
We reanalyzed data on 1749 children in 3 prospective cohorts to obtain coherent estimates of overall VT rate and VT rates net of clearance at different ages. Clearance rates were used to impute the proportion of uninfected children who had been infected and then cleared before testing negative. The proportion of transmission early in utero, late in utero, and at delivery was estimated from data on the proportion of HCV RNA positive within 3 days of birth, and differences between elective cesarean and nonelective cesarean deliveries.
Overall VT rates were 7.2% (95% credible interval [CrI], 5.6%-8.9%) in mothers who were human immunodeficiency virus (HIV) negative and 12.1% (95% CrI, 8.6%-16.8%) in HIV-coinfected women. The corresponding rates net of clearance at 5 years were 2.4% (95% CrI, 1.1%-4.1%), and 4.1% (95% CrI, 1.7%-7.3%). We estimated that 24.8% (95% CrI, 12.1%-40.8%) of infections occur early in utero, 66.0% (95% CrI, 42.5%-83.3%) later in utero, and 9.3% (95% CrI, 0.5%-30.6%) during delivery.
Overall VT rates are about 24% higher than previously assumed, but the risk of infection persisting beyond age 5 years is about 38% lower. The results can inform design of trials of interventions to prevent or treat pediatric HCV infection, and strategies to manage children exposed in utero.
普遍认为，HCV 垂直传播（VT）的风险在单感染女性中为 5%-6%，并且 25%-40%的 HCV 感染会在 5 年内自发清除。然而，对于如何估计 VT 率还没有达成共识，而且对于清除后 VT 率的信息也很缺乏。
我们重新分析了 3 个前瞻性队列中 1749 名儿童的数据，以获得总体 VT 率和不同年龄时清除后 VT 率的一致估计值。清除率用于推断在检测阴性之前已经感染但随后清除的未感染儿童的比例。从出生后 3 天内 HCV RNA 阳性的比例以及选择性剖宫产和非选择性剖宫产之间的差异，估计了宫内早期、宫内晚期和分娩时传播的比例。
在 HIV 阴性的母亲中，总体 VT 率为 7.2%（95%可信区间[CrI]，5.6%-8.9%），在 HIV 合并感染的母亲中为 12.1%（95% CrI，8.6%-16.8%）。5 年后清除后的相应率分别为 2.4%（95% CrI，1.1%-4.1%）和 4.1%（95% CrI，1.7%-7.3%）。我们估计，24.8%（95% CrI，12.1%-40.8%）的感染发生在宫内早期，66.0%（95% CrI，42.5%-83.3%）发生在宫内晚期，9.3%（95% CrI，0.5%-30.6%）发生在分娩时。
总体 VT 率比之前假设的高出约 24%，但在 5 岁后持续感染的风险则降低了约 38%。研究结果可为预防或治疗小儿 HCV 感染的干预措施的临床试验以及处理宫内暴露儿童的策略提供信息。
