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Goins EC, Wein LE, Watkins VY, Campbell AIK, Heine RP, Hughes BL, Dotters-Katz SK, Federspiel JJ. Maternal and neonatal outcomes in patients with hepatitis C and intrahepatic cholestasis of pregnancy: The sum of the parts. PLoS One 2023; 18:e0293030. [PMID: 37851654 PMCID: PMC10584137 DOI: 10.1371/journal.pone.0293030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 10/04/2023] [Indexed: 10/20/2023] Open
Abstract
OBJECTIVE Hepatitis C virus and intrahepatic cholestasis of pregnancy (ICP) are well-known independent risk factors for adverse outcomes in pregnancy. In addition, it is well-established that there is an association between Hepatitis C and ICP. This study's objective was to describe the impact of having both Hepatitis C and ICP on maternal and obstetric outcomes compared to patients having either Hepatitis C or ICP. METHODS We conducted a retrospective cohort study of the Nationwide Readmissions Database, an all-payor sample of discharges from approximately 60% of US hospitalizations. Deliveries at 24-42+ weeks between 10/2015 and 12/2020 were included. Diagnosis of Hepatitis C and ICP, and outcomes related to severe maternal morbidity were identified using International Classification of Disease-10 codes. Patients were categorized based on Hepatitis C and ICP status. Weighted logistic and negative binomial regression analyses were used to evaluate the association between Hepatitis C and ICP status and outcomes, adjusting for patient and hospital characteristics. The primary outcome was any severe maternal morbidity; secondary outcomes included acute respiratory distress syndrome, acute kidney injury, sepsis, gestational diabetes, cesarean delivery, preterm birth, and hospital length of stay. We modeled interaction terms between ICP and Hepatitis C to assess whether there was a greater or lesser effect from having both conditions on outcomes than we would expect from additive combination of the individual components (i.e., synergy or antagonism). RESULTS A total of 10,040,850 deliveries between 24-42+ weeks were identified. Of these, 45,368 had Hepatitis C only; 84,582 had ICP only; and 1,967 had both Hepatitis C and ICP. Patients with both Hepatitis C and ICP had 1.5-fold higher odds of developing severe maternal morbidity compared to having neither. There was an also an increased odds of severe maternal morbidity in patients with both Hepatitis C and ICP compared to patients with only Hepatitis C or ICP. Having both was also associated with higher odds of preterm birth and length of stay compared to having only Hepatitis C, only ICP, or neither (preterm birth: aOR 5.09, 95% CI 4.87-5.33 vs. neither; length of stay: 46% mean increase, 95% CI 35-58% vs. neither). Associations were additive-no significant interactions between hepatitis C and cholestasis were found on rates of severe maternal morbidity, acute respiratory distress syndrome, acute kidney injury, sepsis, cesarean section, or preterm birth (all p>0.05), and was minimal for gestational diabetes and length of stay. CONCLUSION Hepatitis C and ICP are independent, additive risk factors for adverse maternal and obstetric outcomes. Despite physiologic plausibility, no evidence of a synergistic effect of these two diagnoses on outcomes was noted. These data may be useful in counseling patients regarding their increased risk of adverse outcomes when ICP presents in association with Hepatitis C versus ICP alone.
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Affiliation(s)
- Emily C. Goins
- Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Lauren E. Wein
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Virginia Y. Watkins
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Alexa I. K. Campbell
- Duke University School of Medicine, Durham, North Carolina, United States of America
| | - R. Phillips Heine
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States of America
| | - Brenna L. Hughes
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Sarah K. Dotters-Katz
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Jerome Jeffrey Federspiel
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Department of Gynecology and Obstetrics, The Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
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Fogel RS, Chappell CA. Hepatitis C Virus in Pregnancy: An Opportunity to Test and Treat. Obstet Gynecol Clin North Am 2023; 50:363-373. [PMID: 37149316 DOI: 10.1016/j.ogc.2023.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
With the advent of safe and well-tolerated direct-acting antiviral (DAA) medications for hepatitis C virus (HCV), disease eradication is on the horizon. However, as the rate of HCV infection among women of childbearing potential continues to rise due to the ongoing opioid epidemic in the United States, perinatal transmission of HCV presents an increasingly difficult barrier. Without the ability to treat HCV during pregnancy, complete eradication is unlikely. In this review, we discuss the current epidemiology of HCV in the United States, the current management strategy for HCV in pregnancy, as well as the potential for future use of DAAs in pregnancy.
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Affiliation(s)
- Rachel S Fogel
- University of Pittsburgh School of Medicine, 3550 Terrace Street, Pittsburgh, PA 15213, USA
| | - Catherine A Chappell
- Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital, 300 Halket Street, Pittsburgh, PA 15213, USA; Magee-Womens Research Institute, 204 Craft Avenue, Pittsburgh, PA 15213, USA.
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Chudnovets A, Liu J, Narasimhan H, Liu Y, Burd I. Role of Inflammation in Virus Pathogenesis during Pregnancy. J Virol 2020; 95:e01381-19. [PMID: 33115865 PMCID: PMC7944452 DOI: 10.1128/jvi.01381-19] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Viral infections during pregnancy lead to a spectrum of maternal and fetal outcomes, ranging from asymptomatic disease to more critical conditions presenting with severe maternal morbidity, stillbirth, preterm birth, intrauterine growth restriction, and fetal congenital anomalies, either apparent at birth or later in life. In this article, we review the pathogenesis of several viral infections that are particularly relevant in the context of pregnancy and intrauterine inflammation. Understanding the diverse mechanisms employed by viral pathogens as well as the repertoire of immune responses induced in the mother may help to establish novel therapeutic options to attenuate changes in the maternal-fetal interface and prevent adverse pregnancy outcomes.
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Affiliation(s)
- Anna Chudnovets
- Integrated Research Center for Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jin Liu
- Integrated Research Center for Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Harish Narasimhan
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Yang Liu
- Integrated Research Center for Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Irina Burd
- Integrated Research Center for Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Aboubakar M, Kpossou AR, Glago BRGH, Aguiah AG, Mboreha ZH, Sehonou J. [Prevention and factors associated with anti-HCV carriage in pregnant women living in Cotonou]. Pan Afr Med J 2020; 36:182. [PMID: 32952826 PMCID: PMC7467609 DOI: 10.11604/pamj.2020.36.182.23122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/08/2020] [Indexed: 12/15/2022] Open
Abstract
Introduction hepatitis C is an infection which can be passed from mother to child. The purpose of this study was to investigate the prevalence of colonization by anti-HCV antibodies in pregnant women living in Cotonou and to identify factors associated with it. Methods we conducted a cross-sectional study of 253 pregnant women admitted for prenatal care in four major maternity hospitals in Cotonou (Benin) from 01/06/2018 to 01/09/2018. Anti-HCV antibodies were detected using rapid diagnostic tests. A venous blood sample was collected from pregnant women tested positive for anti-HCV before confirmatory serological tests and screening tests for gestational diabetes. Results the prevalence of anti-HCV antibodies was 1.2% (3/253 pregnant women). Factors associated with HCV carriage couldn't be identified given the low number of positive cases. However, pregnant women who were carriers of hepatitis C antibodies had higher mean age (32 ± 3) compared to the remainder of the population (29.58 ± 5.5). Potential risk factors for HCV infection were scarifications, piercing, tattooing, sharing of manicure equipment, a history of surgery and blood transfusions. The prevalence of gestational diabetes in our study population was 7.9% (20/253). No association was found between gestational diabetes and hepatitis C. Conclusion the prevalence of anti-HCV antibodies in pregnant women living in Cotonou was low. A national-level study is needed to identify factors associated with this infection.
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Affiliation(s)
- Moufalilou Aboubakar
- Centre Hospitalier Universitaire de la Mère et de l´Enfant Lagune (CHU-MEL), Cotonou, Bénin
| | - Aboudou Raïmi Kpossou
- Clinique Universitaire d´Hépato-gastro-entérologie, Centre National Hospitalier et Universitaire Hubert Koutoukou Maga (CNHU-HKM), Cotonou, Bénin
| | | | - Amel Gildas Aguiah
- Clinique Universitaire de Gynécologie-obstétrique, Centre National Hospitalier et Universitaire Hubert Koutoukou Maga (CNHU-HKM), Cotonou, Bénin
| | - Zafy Hairou Mboreha
- Centre Hospitalier Universitaire de la Mère et de l´Enfant Lagune (CHU-MEL), Cotonou, Bénin
| | - Jean Sehonou
- Clinique Universitaire d´Hépato-gastro-entérologie, Centre National Hospitalier et Universitaire Hubert Koutoukou Maga (CNHU-HKM), Cotonou, Bénin
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Çınar Tanrıverdi E, Özkurt Z, Göktuğ Kadıoğlu B, Alay H, Çalıkoğlu O, Koca Ö, Kamalak Z. Seroprevalence of hepatitis B, hepatitis C, and HIV in pregnant women from Eastern Turkey. TURKISH JOURNAL OF GASTROENTEROLOGY 2019; 30:260-265. [PMID: 30541714 DOI: 10.5152/tjg.2018.17634] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND/AIMS The vertical transmission of hepatitis B virus, hepatitis C virus (HCV), and human immunodeficiency virus (HIV) infections are essential public health problems. In this study, we aimed to investigate the seroprevalence of the aforementioned infections among pregnant women. MATERIALS AND METHODS This study was done retrospectively on pregnant women who presented for antenatal follow-up and delivery between 2013 and 2016. Data were collected from the hospital's electronic health records and patient files. Blood samples were analyzed at the microbiology laboratory of the hospital. HBsAg, anti-HBs, anti-HCV, and anti-HIV titers were tested using the chemiluminescence enzyme immunoassay method (Architect, Abbott Laboratories, USA). RESULTS HBsAg and anti-HBs levels were tested in 35,295 pregnant women aged 18-45 years. The HBsAg and anti-HBs levels were positive in 425 (1.2%) and 9583 (27.7%) patients, respectively. From 2013 to 2016, the HBV carrier rates have continuously decreased from 1.4% to 0.8%, whereas the anti-HBs positivity has increased from 25.4% to 30.2%. Anti-HCV was detected in 6 of the 9709 (0.06%) patients. All the 7113 pregnant women screened for HIV showed negative results. CONCLUSION Hepatitis B carrier rates among pregnant women gradually decreased with a simultaneous increase in the immunity rates. HCV seroprevalence was low and HIV positivity was not encountered in the study population.
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Affiliation(s)
- Esra Çınar Tanrıverdi
- Department of Medical Education, Gynecology and Obstetrics, Atatürk University School of Medicine, Erzurum, Turkey
| | - Zülal Özkurt
- Department of Infectious Diseases, Atatürk University School of Medicine, Erzurum, Turkey
| | | | - Handan Alay
- Department of Infectious Diseases, Nenehatun Maternity Hospital, Erzurum, Turkey
| | - Okşan Çalıkoğlu
- Department of Public Health, Atatürk University School of Medicine, Erzurum, Turkey
| | - Özlem Koca
- Department of Microbiology, Atatürk Regional Hospital, Antalya, Turkey
| | - Zeynep Kamalak
- Department of Gynecology and Obstetrics, Buhara Hospital, Erzurum, Turkey
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Orekondy N, Cafardi J, Kushner T, Reau N. HCV in Women and Pregnancy. Hepatology 2019; 70:1836-1840. [PMID: 31135999 DOI: 10.1002/hep.30791] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 05/23/2019] [Indexed: 12/12/2022]
Affiliation(s)
| | - John Cafardi
- Department of Infectious Disease, Christ Hospital, Cincinnati, OH
| | - Tatyana Kushner
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Nancy Reau
- Section of Hepatology, Rush University Medical Center, Chicago, IL
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Parent S, Salters K, Awendila L, Ti L. Hepatitis C and pregnancy outcomes: a systematic review protocol. BMJ Open 2018; 8:e024288. [PMID: 30580273 PMCID: PMC6318518 DOI: 10.1136/bmjopen-2018-024288] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 09/24/2018] [Accepted: 11/20/2018] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Many women living with hepatitis C (HCV) are of childbearing age. While the risk of vertical HCV transmission has been well established, the impact of HCV on pregnancy outcomes are equivocal, with some studies reporting risks of preterm birth, low gestational weight, gestational diabetes and hypertension, while other studies report no such risks. With the shift of the HCV treatment landscape to more effective, tolerable and shorter medications, understanding pregnancy outcomes of women living with HCV are an important consideration in order to provide a baseline from which to consider the usefulness and safety of HCV treatment for this population. The objective of this systematic review will be to investigate pregnancy outcomes associated with maternal HCV infection. METHODS AND ANALYSIS This systematic review will incorporate articles relevant to pregnancy outcomes among women living with HCV (eg, gestational diabetes and caesarean delivery). Articles will be retrieved from academic databases including MEDLINE, EMBASE, CINAHL, clinicaltrial.gov and the Cochrane Library and hand searching of conference proceedings and reference lists. A database search will not be restricted by date, and conference abstract will be restricted to the past 2 years. The Newcastle-Ottawa Quality Assessment Scale will be used to assess the quality of the retrieved studies. Data will be extracted and scored independently by two authors. A narrative account will synthesise the findings to answer the objectives of this review. ETHICS AND DISSEMINATION This systematic review will synthesise the literature on the pregnancy outcomes of women living with HCV. Results from this review will be disseminated to clinical audiences, community groups and policy-makers, and may support clinicians and decision-makers in developing guidelines to promote best outcomes for this population.
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Affiliation(s)
- Stephanie Parent
- British Columbia Centre for Excellence in HIV/AIDS, St Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Kate Salters
- British Columbia Centre for Excellence in HIV/AIDS, St Paul’s Hospital, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, University Drive, Burnaby, Burnaby, British Columbia, Canada
| | - Lindila Awendila
- British Columbia Centre for Excellence in HIV/AIDS, St Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Lianping Ti
- Department of Medicine, University of British Columbia, St Paul’s Hospital, Vancouver, British Columbia, Canada
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
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Martin-Santos R, Egmond E, Cavero M, Mariño Z, Subira S, Navines R, Forns X, Valdes M. Chronic hepatitis C, depression and gender: a state of art. ADVANCES IN DUAL DIAGNOSIS 2015. [DOI: 10.1108/add-05-2015-0009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Purpose
– The purpose of this paper is to provide a comprehensive overview of the current knowledge regarding chronic hepatitis C (CHC) infection, antiviral therapy, depression, and gender.
Design/methodology/approach
– CHC and its treatment options were reviewed examining their relationship with depression and gender.
Findings
– CHC is a high prevalent chronic infection worldwide, being similar in men and women. However, the infection shows many gender differences in terms of innate response, genetic variability (i.e. IL-28B), route of transmission (i.e. intravenous drug use), disease progression (i.e. fibrosis), lifetime period (i.e. pregnancy), and risk factors (i.e. HIV). Both the hepatitis C infection and antiviral treatment (especially when using the pro-inflammatory cytokine interferon α), are highly associated with depression, where female gender constitutes a risk factor. It seems that the new direct-acting antiviral combinations produce fewer neuropsychiatric side effects. In fact, the presence of depression at baseline is no longer a limitation for the initiation of antiviral treatment. Antidepressant drugs have been recommended as current depression and prophylactic treatment in risk subgroups. However, caution should be exercised due to the risk of drug-drug interactions with some antiviral drugs. Women should be counselled prenatal, during and after pregnancy, taking into account the clinical situation, and the available evidence of the risks and benefits of antiviral and antidepressant treatments. Multidisciplinary approach shows cost-efficacy results.
Originality/value
– The paper clarifies the complex management of CHC therapy and the importance of individualizing treatment. The results also underline the need for an integrated multidisciplinary approach.
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Obstetrical and neonatal outcomes among women infected with hepatitis C and their infants. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2015; 36:785-794. [PMID: 25222357 DOI: 10.1016/s1701-2163(15)30480-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES (1) To describe obstetrical and neonatal outcomes among a cohort of hepatitis C virus (HCV) infected women, comparing HCV RNA positive to HCV RNA negative women; (2) to characterize virologic and hepatic parameters associated with HCV infection during pregnancy; and (3) to describe the rate of HCV vertical transmission. METHODS We prospectively enrolled 145 HCV-positive pregnant women across British Columbia between 2000 and 2003. Participating women were monitored during pregnancy and their infants were followed to assess them for HCV infection. Maternal HCV RNA was assessed close to delivery. RESULTS Seventy percent of women reported injection drug use as their primary risk factor for HCV acquisition. Observed rates of intrauterine fetal death, preterm delivery, small for gestational age, and low birth weight infants were 3.4%, 17.9%, 11.3%, and 12.5%, respectively, without a significant association with maternal HCV RNA status. The rate of cholestasis was 5.6% in the HCV RNA-positive group (6/108) and 2.8% in the HCV RNA-negative group (1/37) (P = 0.496). Serum alanine aminotransferase levels decreased significantly through pregnancy, and were significantly higher in HCV RNA-positive women than in HCV RNA-negative women after controlling for cholestasis, co-infections, and alcohol consumption. Among the HCV RNA-positive women, the median FIB-4 score was 0.67 (IQR 0.56 to 0.76) in the first trimester, 0.74 (IQR 0.52 to 1.18) in the second trimester, and 0.89 (IQR 0.52 to 1.09) in the third trimester (P = 0.02). The median HCV viral load at delivery was 424 561 IU/mL. The vertical transmission rate was 4.7% in HCV RNA-positive women, with no cases in HCV RNA-negative women. CONCLUSION Because of the high rates of poor obstetrical outcomes found in this prospective cohort, population-level screening for HCV in pregnancy should be considered.
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Le Campion A, Larouche A, Fauteux-Daniel S, Soudeyns H. Pathogenesis of hepatitis C during pregnancy and childhood. Viruses 2012; 4:3531-50. [PMID: 23223189 PMCID: PMC3528278 DOI: 10.3390/v4123531] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Revised: 11/18/2012] [Accepted: 11/28/2012] [Indexed: 12/13/2022] Open
Abstract
The worldwide prevalence of HCV infection is between 1% and 8% in pregnant women and between 0.05% and 5% in children. Yet the pathogenesis of hepatitis C during pregnancy and in the neonatal period remains poorly understood. Mother-to-child transmission (MTCT), a leading cause of pediatric HCV infection, takes place at a rate of <10%. Factors that increase the risk of MTCT include high maternal HCV viral load and coinfection with HIV-1 but, intriguingly, not breastfeeding and mode of delivery. Pharmacological prevention of MTCT is not possible at the present time because both pegylated interferon alfa and ribavirin are contraindicated for use in pregnancy and during the neonatal period. However, this may change with the recent introduction of direct acting antiviral agents. This review summarizes what is currently known about HCV infection during pregnancy and childhood. Particular emphasis is placed on how pregnancy-associated immune modulation may influence the progression of HCV disease and impact MTCT, and on the differential evolution of perinatally acquired HCV infection in children. Taken together, these developments provide insights into the pathogenesis of hepatitis C and may inform strategies to prevent the transmission of HCV from mother to child.
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Affiliation(s)
- Armelle Le Campion
- Unité d’immunopathologie virale, Centre de recherche du CHU Sainte-Justine, 3175 Côte Sainte-Catherine, local 6735, Montreal, Quebec, H3T 1C5, Canada; E-Mails: (A.L.C); (A.L.); (S.F.-D.)
| | - Ariane Larouche
- Unité d’immunopathologie virale, Centre de recherche du CHU Sainte-Justine, 3175 Côte Sainte-Catherine, local 6735, Montreal, Quebec, H3T 1C5, Canada; E-Mails: (A.L.C); (A.L.); (S.F.-D.)
- Department of Microbiology & Immunology, Faculty of Medicine, Université de Montréal, C.P. 6128, Succ. Centre-ville, Montreal, Quebec, H3C 3J7, Canada
| | - Sébastien Fauteux-Daniel
- Unité d’immunopathologie virale, Centre de recherche du CHU Sainte-Justine, 3175 Côte Sainte-Catherine, local 6735, Montreal, Quebec, H3T 1C5, Canada; E-Mails: (A.L.C); (A.L.); (S.F.-D.)
- Department of Microbiology & Immunology, Faculty of Medicine, Université de Montréal, C.P. 6128, Succ. Centre-ville, Montreal, Quebec, H3C 3J7, Canada
| | - Hugo Soudeyns
- Unité d’immunopathologie virale, Centre de recherche du CHU Sainte-Justine, 3175 Côte Sainte-Catherine, local 6735, Montreal, Quebec, H3T 1C5, Canada; E-Mails: (A.L.C); (A.L.); (S.F.-D.)
- Department of Microbiology & Immunology, Faculty of Medicine, Université de Montréal, C.P. 6128, Succ. Centre-ville, Montreal, Quebec, H3C 3J7, Canada
- Department of Pediatrics, Faculty of Medicine, Université de Montréal, C.P. 6128, Succ. Centre-ville, Montreal, Quebec, H3C 3J7, Canada
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