HCV testing in children and infants
SIGN's guidelines for HCV testing in children and infants and an overview of the supporting evidence.
HCV testing in children and infants
The aim of testing infants born to women with hepatitis C is not primarily to identify all children to whom the virus has been transmitted, but to identify those at risk of persistent infection and its long term consequences.
Infants born to women who are HCV antibody positive will test positive for HCV antibody at birth.48 Infants who are not infected become negative for HCV antibody between 6 and 20 months of age. Around 80% will be negative by 12 months of age.44, 49 Positive results for viral RNA by NAT may be obtained in the early months of life in children who subsequently become negative and lose HCV antibody.48-5148-51 Some infected infants may not become HCV RNA positive until 12 months of age or thereafter.51 A recent study indicates that the sensitivity of a positive RT PCR result obtained on two occasions between two and six months of life in predicting infection is 81% (confidence interval; CI 58-97%).52 2+ 2+
In HIV co-infection, infants consistently positive by RNA may have negative HCV antibody tests between 12 and 18 months of age.53 3
Infants born to women who are HCV antibody positive and HCV RNA negative do not need to be tested.
In children born to women infected with HCV, an HCV antibody test should be performed at 12 months of age or thereafter to identify the majority of children who are not infected.
In children whose mothers are co-infected with HIV, and in infants found to be HCV antibody positive after 12 months, an HCV RNA test should be performed, and if positive, confirmed on a second sample.
If information regarding the risk of HCV infection in an individual child is required before 12 months of age, an HCV RNA test and retest can be performed after 2 months of age. Further testing is still required to make a definitive diagnosis.
