丙型肝炎病毒（HCV）垂直传播综述：感染或未感染HCV病毒血症或人类免疫缺陷病毒的母亲所生婴儿的传播风险

A review of hepatitis C virus (HCV) vertical transmission: risks of transmission to infants born to mothers with and without HCV viraemia or human immunodeficiency virus infection.

作者信息

Thomas S L, Newell M L, Peckham C S, Ades A E, Hall A J

机构信息

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

出版信息

Int J Epidemiol. 1998 Feb;27(1):108-17. doi: 10.1093/ije/27.1.108.

DOI:10.1093/ije/27.1.108

PMID:9563703

Abstract

BACKGROUND

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

METHODS

Systematic review of worldwide published and unpublished HCV vertical transmission studies. Standardized diagnostic criteria were applied to minimize methodological differences, and transmission rates recalculated according to maternal HCV 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 HCV 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, HCV transmission is largely restricted to infants born to HCV viraemic mothers, and low risks among most HIV negative mothers may be due to lower HCV viraemia levels. International agreement on standardized diagnostic criteria for HCV vertical transmission would facilitate pooling of individual findings, to allow more precise transmission estimates and further investigation of risk factors.

摘要

背景

丙型肝炎病毒（HCV）垂直传播的研究报告结果相互矛盾，这可能是由于孕产妇群体中HCV传播风险因素存在差异，或者是由于方法学上的差异。

方法

对全球已发表和未发表的HCV垂直传播研究进行系统评价。应用标准化诊断标准以尽量减少方法学差异，并根据孕产妇HCV病毒血症和人类免疫缺陷病毒（HIV）感染状况重新计算传播率。

结果

总共对28项研究中的976名符合条件的婴儿进行了充分随访，以便重新计算传播率。在12项针对HIV阴性母亲的研究中，有8项的总体传播率低于10%，而在7项至少50%为HIV合并感染母亲的研究中，这一比例为2/7。15项研究中409名病毒血症母亲的传播率在0%至41%之间，在13项针对HIV阴性母亲的研究中，有6项传播率低于10%，在6项针对HIV阳性母亲的研究中，有1项传播率低于10%。9项研究测量了孕产妇病毒血症水平，在30名传播病毒的母亲中，只有2名的HCV RNA低于10⁶拷贝/毫升。总体上从非病毒血症母亲中发现了8例传播。在考虑了孕产妇病毒血症和HIV合并感染因素后仍存在显著的传播率差异，这可能是由于其他垂直传播风险因素的差异、产后传播频率的差异或研究方法上的残余差异。