![]() ![]() Screening of pregnant women who do not have known risk factors for infection as a method of prevention of perinatal transmission has remained a great challenge owing to the unavailability of HCV vaccine and the lack of an approved antiviral therapy during pregnancy. Testing for HCV-RNA is essential to differentiate those with chronic infection from those who have spontaneously cleared the virus. Seropositive children at 18 months of age or older are generally believed to have been perinatally infected with HCV. Perinatal transmission leads to acquisition of HCV very early in life – in the intrauterine period (antenatal/antepartum), during delivery (natal/intrapartum) or after delivery (postnatal/postpartum) – with the consequence of chronic liver disease and liver cancer in early adulthood. Nowadays, and especially in developed countries, perinatal transmission of HCV is considered the main cause of HCV infection in children. Before universal screening of blood and blood products, which started in 1992, HCV was transmitted mostly through transfusions and organ transplants. Recently, HCV has emerged as the most important cause of chronic viral hepatitis in children in many countries. When considering the health burden and dynamics of HCV infection, pregnant women and their infants represent a group with special physiological changes which can cause a modified course of chronic HCV and subsequently needs special considerations. Until 2011, the historically accepted standard of care therapy was pegylated interferon (Peg-IFN) and ribavirin (RBV), producing a sustained virologic response in almost half of the patients for genotype 1 and higher rates up to 50% for other genotypes. Nowadays, HCV is the main indication for adult liver transplantation. Percutaneous inoculation is the commonest mode of HCV transmission, but sexual, household, occupational, and vertical transmission can also occur. Moreover, there are controversies between researchers as some of them suggested a decreasing trend of HCV prevalence while others expected an increasing burden. There is great variability in HCV prevalence rate from one country to another and even within the same country from one region to another. ![]() It is estimated to chronically affect ~3% of the world’s population (~170 million people), with more than one million new cases annually. It can cause chronic hepatitis and liver cirrhosis and represents the main risk factor of primary hepatocellular carcinoma. Hepatitis C virus (HCV) infection is a major health problem all over the world. The recently approved new-generation, oral, direct-acting antiviral drugs may open a new era in HCV therapy for pregnant women and infected infants if proved to be safe during conception and infancy. Infection during pregnancy and infancy needs to be investigated more in order to design management strategies for perinatal transmission of HCV most effectively. Intrauterine and partum transmission of HCV are both possible and higher rates are associated with a high maternal serum viral load (> 10 6 copies per milliliter), concomitant HIV infection, prolonged or difficult delivery, and invasive fetal monitoring during delivery. Universal antenatal screening for HCV is largely debatable. HCV has no effective immune prophylaxis and hence appropriate follow-up of all infants born to HCV-infected mothers is necessary. A large proportion of perinatal HCV infections are silent and may present later in adulthood with long-term complications. Infection with hepatitis C virus (HCV) is a major health problem worldwide. ![]()
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