Granovsky M O, Minkoff H L, Tess B H, Waters D, Hatzakis A, Devoid D E, Landesman S H, Rubinstein A, Di Bisceglie A M, Goedert J J
Division of Cancer Epidemiology and Genetics, Viral Epidemiology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20852, USA.
Pediatrics. 1998 Aug;102(2 Pt 1):355-9. doi: 10.1542/peds.102.2.355.
To estimate the hepatitis C virus (HCV) vertical transmission rate, the effect of potential risk factors, and the pattern of HCV antibody response and viremia in HCV-infected infants.
The Mothers and Infants Cohort Study enrolled both human immunodeficiency virus (HIV)-seropositive and HIV-seronegative pregnant women at five obstetric clinics in New York City in a prospective cohort study between January 1986 and January 1991. HCV-infected mothers and their 122 offspring were followed-up for a minimum of 12 months for evidence of HCV infection as determined by persistent HCV antibodies or detection of HCV RNA by reverse transcription polymerase chain reaction. Comparisons among groups for categorical variables were performed using the Fisher's exact test.
Seven (6%; 95% confidence interval, 2%-11%) of the 122 infants were HCV-infected. There was a tendency for increased risk of transmission with maternal viral and obstetrical factors, such as coinfection with HIV (7% vs 4%), high HIV viral load (13% vs 6%), HCV viremia (8% vs 3%), vaginal delivery (6% vs 0%), and female gender of offspring (8% vs 3%), although none of the associations reached statistical significance. After loss of maternal antibody, HCV antibody seroconversion occurred at a mean age of 26 months in 3 HIV-coinfected infants compared with 7 months of age in 4 HCV-infected HIV-uninfected infants. Serial samples showed that HCV RNA persisted in 6 infants for at least 18 to 54 months.
Our study is in accordance with other studies that have shown low overall HCV vertical transmission risk and a trend toward higher risk with maternal risk factors such as HIV-coinfection or HCV viremia. A delay in infant HCV antibody response may be associated with HIV coinfection although larger studies are needed to confirm these findings.
评估丙型肝炎病毒（HCV）垂直传播率、潜在危险因素的影响，以及HCV感染婴儿的HCV抗体反应模式和病毒血症情况。
母婴队列研究于1986年1月至1991年1月在纽约市的五家产科诊所开展，纳入了人类免疫缺陷病毒（HIV）血清学阳性和HIV血清学阴性的孕妇，进行前瞻性队列研究。对HCV感染的母亲及其122名后代进行了至少12个月的随访，通过持续存在的HCV抗体或逆转录聚合酶链反应检测HCV RNA来确定HCV感染证据。分类变量组间比较采用Fisher精确检验。
122名婴儿中有7名（6%；95%置信区间，2%-11%）感染了HCV。母婴病毒和产科因素如HIV合并感染（7%对4%）、高HIV病毒载量（13%对6%）、HCV病毒血症（8%对3%）、阴道分娩（6%对0%）以及后代女性性别（8%对3%）有增加传播风险的趋势，尽管这些关联均未达到统计学显著性。在母亲抗体消失后，3名HIV合并感染婴儿的HCV抗体血清学转换平均发生在26个月龄，而4名HCV感染但未感染HIV婴儿的HCV抗体血清学转换平均发生在7个月龄。系列样本显示，6名婴儿的HCV RNA持续存在至少18至54个月。
我们的研究与其他研究一致，表明HCV总体垂直传播风险较低，且存在如HIV合并感染或HCV病毒血症等母亲危险因素时传播风险有升高趋势。婴儿HCV抗体反应延迟可能与HIV合并感染有关，尽管需要更大规模的研究来证实这些发现。
