Children and HCV
This section gives the SIGN guidance on mother to child transmission of HCV and of the natural progression of the disease in children.
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Mother to child transmision
Pregnant women who are HCV RNA negative do not pose a risk of transmission to their child. 44, 45 2+
The risk of women who are HCV infected and RNA positive transmitting infection to their babies in utero or during parturition is approximately five per cent; the rate is twice as high for those co-infected with HIV. 46 The baby’s risk of acquiring HCV from a mother infected with HCV is not increased by mode of delivery or breast feeding. 46 One prospective study has indicated that fetal scalp monitoring may increase the risk of mother to child transmission. 47 A large retrospective study did not demonstrate any excess risk. 46 Vaginal delivery may increase the risk of HCV transmission if the mother is co-infected with detectable HIV viral load. 46 2++
In pregnant women knowledge of HCV RNA positive status should not influence obstetric management or standard advice regarding breast feeding.
Natural history of hcv infection in children
Cross-sectional studies indicate that 20-40% of children who are HCV antibody positive after 18 months of age have undetectable HCV RNA, suggesting spontaneous clearance.54, 55In those with chronic infection who remain HCV RNA positive, subsequent spontaneous clearance is rare (3.5%).56 3
Levels of transaminases (ALT) twice the upper limit of normal are found in 50% of infected children.56 3
Progression to severe hepatitis or cirrhosis in childhood is rare (<5%).54, 56-58 There is a slow, non-linear progression of fibrosis with age.56, 57. The mean time to development of cirrhosis in individuals infected as infants is estimated at 28 years.57 3
Children infected with HCV should be monitored to identify the minority who are at risk of progressive fibrosis during childhood, and who may be candidates for treatment.
Good practice points
Children infected with HCV should be assessed clinically every 6-12 months, and have blood taken for tests of liver function. Those with clinical or ultrasound abnormalities, or with serum ALT persistently twice the upper limit of normal should be considered for liver biopsy.
