PROPHYLACTIC MEASURES AGAINST INFECTION WITH HEPATITIS C VIRUS AND HIV IN INFANTS
Abstract
Background. The World Health Organization estimates that every year more then 500,000 infants get infected with human immunodeficiency virus (HIV) and 10,000– 60,000 with hepatitis C virus (HCV) worldwide.
Rapid and early diagnosis of HCV and HIV infection in exposed infants is rendered difficult because of transplacental passage of maternal IgG antibodies to the virus that are present in infants up to 18 months of age. Mother-to-infant transmission of HCV is comparatively uncommon. Furthermore, chronic hepatitis C does not appear to worsen the outcome of pregnancy or predispose fetal abnormalities.
The rate of mother-to-infant transmission is 4 to 7% per pregnancy in women with HCV viremia. Perinatal infection with HCV is usually asymptomatic. Concomitant infection in pregnant women with HIV increases the rate of transmission of HCV infection 4 to 5 fold. Cesarean section is not recommended and current available medications against HCV infection are contraindicated because of fetal toxicity. Breast-feeding poses no relevant risk of HCV transmission.
Conclusions. Perinatal transmission of HIV from mother to child accounts to 5 to 10% of acquired HIV infections worldwide. It is by far the major source of infection and represents more that 90% of all infections in children. Transmission of HIV occurs either before birth, during delivery or through breastfeeding.
Recently, zidovudine and some other antiretrovirals administered during pregnancy, at delivery, and in the first 6 weeks of life to the infant have reduced transmission by more than two thirds (from 25 to less than 5%). The experts have also recommended elective cesarean section and dissuaded HIV positive mothers from breastfeeding.
Experts must also test strategies to further decrease the risk for perinatal HCV and HIV infection. Significant progress in the area of new safe and effective vaccines is eagerly expected.
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References
Yeung LTF, King SM, Roberts EA. Mother-to-infant transmission of hepatitis C virus. Hepatology 2001; 34: 223–9.
Tovo PA, Newell ML. Hepatitis C in children. Curr Opin Infect Dis 1999; 12: 245–50.
Roberts EA, Yeung L. Maternal-infant transmission of hepatitis C virus infection. Hepatology 2002; 36: 106–13.
Zahim D, Boyer TD. Hepatology. In: Hoofnagle JH, Heller T. Hepatitis C. Philadelphia: Saunders, 2003: 1017–62.
Fowler MG, Simonds RJ, Roongpisuthipong A. Update on perinatal HIV transmission. Pediatric Clin North Am 2000; 47: 21–38.
Armstrong D, Cohen J. Infectious diseases. In: Ford-Jones EL, Ryan G. Implications for the fetus of maternal infectious in pregnancy. London: Mosby, 1999: 2.55.1–2.55.13.
Behrman RE, Vaughan VC. Nelson textbook of Pediatric. In: Yogev R, Chadwick EG. Acquired immunodeficiency syndrome. Philadelphia: Saunders, 2000: 1022–32.
Root RK. Clinical infectious diseases. In: Crabbe F, Laga M, Piot P. Human immunodeficiency virus and AIDS. New York: Oxford University Press, 1999: 905–13.
Čižman M, Arnež M, Pokorn M. HIV-okužba v otroški dobi. I. Klinični simpozij o AIDSU. Med Razgl 1997; 36: Suppl 1: 99–121.
Marolt-Gomišček M, Radšel-Medvešček A. Infekcijske bolezni. In: MaroltGomišček M. Sindrom pridobljene imunske pomanjkljivosti – AIDS. Ljubljana: Tangram, 2000: 443–70.
Conte D, Fraquelli M, Prati D, Colucci A, Minola E. Prevalence and clinical course of chronic hepatitis C virus (HCV) infection and rate of HCV vertical transmission in a cohort of 15,250 pregnant women. Hepatology 2000; 31: 751–5.
Jonas MM. Children with hepatitis C. Hepatology 2002; 36: S173–8.
Jara P, Resti M, Hierro L et al. Chronic hepatitis C virus infection in childhood: Clinical patterns and evolution in 224 white children. Clin Infect Dis 2003; 36: 275–80.
Lešničar G, Pojak M, Seme K et al. Our experiences in treatment of chronic hepatitis C with recombinant interferon alpha (Abs.). In 7th European Congress of clinical microbiology and infectious diseases.Vienna: 1995, 180–0.
Lešničar G. Letna poročila Oddelka za infekcijske bolezni in vročinska stanja Splošne bolnišnice Celje od l. 1985 do 2003. Celje: Splošna bolnišnica, 2003.
Tovo PA, Pembrey LJ, Newell ML. Persistence rate and progression of vertically acquired hepatitis C infection. J Infect Dis 2000; 181: 419–24.
John AM, Kumar A, Cave C. Reduction in perinatal transmission and mortality from human immunodeficiency virus after intervention with zidovudine in Barbados. Pediatr Infect Dis J 2003; 22: 422–6.
Moodley D, Moodley J, Coovadia H et al. A multicenter randomized controlled trial of nevirapine versus a combination of zidovudine and lamivudine to reduce intrapartum and early postpartum mother-to-child transmission of human immunodeficiency virus type 1. J Infect Dis 2003; 187: 725–35.
Pancharoen C, Thisyakorn U. Preventive strategies of perinatal HIV-1 transmission: an experience from Thailand. Expert Opin Pharmacother 2003; 4: 179–82.
Stringer EM, Sinkala M, Stringer JS et al. Prevention of mother-to-child transmission of HIV in Africa: successes and challenges in scaling-up a nevirapine-based program in Lusaka, Zambia. AIDS 2003; 17: 1377–82.
Tavel JA, Miller KD, Masur H. Guide to major clinical trials of antiretroviral therapy in human immunodeficiency virus-infected patients: Protease inhibitors, non-nucleoside reverse transcriptase inhibitors, and nucleotide reverse transcriptase inhibitors. Clin Infect Dis 1999; 28: 643–76.
Scarlatti G. Pediatric HIV infection. Lancet 1996; 348: 863–8.
Landersman SH, Kalish LA, Burns DN et al. Obstetrical factors and the transmisssion of human immunodeficiency virus type 1 from mother to child. N Engl J Med 1996; 334: 1617–23.
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