A new study on hepatitis C: What it means to me

Question: I am a practising paediatrician in Montreal, and a two-week-old infant has just become my patient. She was born to a hepatitis C virus (HCV)-positive intravenous drug user. Is the infant infected with hepatitis C?

Answer: A new study will answer questions on HCV infection by reaffirming the results of previous studies to support, in part, routine testing of pregnant women for HCV infection and to indicate the optimum timing of RNA polymerase chain reaction (PCR) testing of the newborn. Because HCV is inefficiently spread by sexual contact and screening of the Canadian blood supply is now in place, mother-to-child transmission is becoming the only risk factor for HCV acquisition in children. Currently, there is insufficient evidence on which to base recommendations for ante-, intra- and postpartum management of HCV-infected pregnant women to prevent transmission to their offspring. In addition, some evidence on the natural history and clinical course of HCV infection indicates that spontaneous clearance of HCV infections occurs more frequently in children than in adults. Research provides estimates of the accuracy of HCV RNA PCR tests. This is important for planning the timing (probably one month of age) of diagnostic tests and their interpretation, particularly in children born to mothers who are intravenous drug users and in whom follow-up may be difficult. If the study results confirm that elective cesarian section is associated with a lower risk of transmission than vaginal or emergency cesarian section delivery, the case for antenatal HCV testing may have to be revisited.