Hepatitis C virus infection in pregnancy and childhood

Abstract

Both pregnancy and childhood uniquely affect the natural history of hepatitis C virus (HCV) infection. Chronically infected women frequently experience a rise in plasma viral levels and decline in hepatic transaminases in the latter half of pregnancy, likely due in part to suppression of HCV-specific cellular immunity by maternofetal tolerance mechanisms. These changes reverse following delivery, with viremia sometimes declining sharply due to an apparent postpartum resurgence of HCV-specific immunity. While pregnancy influences the natural history of HCV, recent studies suggest that HCV infection may also affect pregnancy, predisposing to premature delivery and other adverse outcomes. About 4-6% of pregnancies to viremic mothers result in utero or peripartum vertical transmission, which is now the primary route of childhood HCV infection. Currently no antiviral therapies or prophylactic interventions are available to prevent the vertical transmission of HCV. Hepatitis C acquired in childhood appears to follow a distinct course from infection acquired in adulthood. In the acute phase of infection, hepatic transaminases usually rise less dramatically in young children than in adults. Children may spontaneously resolve infection at least as often as adults, and some studies suggest they retain capacity to resolve infection over a more prolonged period of time. Persistently infected children demonstrate a slower progression of liver fibrosis than adults, though more studies are needed to understand the long-term outcome of pediatric HCV infection. Immunological mechanisms governing vertical transmission and the natural history of HCV in children remain poorly understood. Standard therapy for children remains interferon and ribavirin while clinical trials are underway to test direct acting antiviral regimens in this population.