Vertical transmission of hepatitis C virus: Systematic review and meta-analysis

Lenka Benova, Yousra A. Mohamoud, Clara Calvert, Laith Aburaddad

Research output: Contribution to journalArticle

133 Citations (Scopus)

Abstract

Background. We conducted a systematic review of estimates of hepatitis C virus (HCV) vertical transmission risk to update current estimates published more than a decade ago. Methods. PubMed and Embase were searched and 109 articles were included. Pooled estimates of risk were generated for children born to HCV antibody-positive and viremic women, aged ≥18 months, separately by maternal human immunodeficiency virus (HIV) coinfection. Results. Meta-analysis of the risk of vertical HCV infection to children of HCV antibody-positive and RNA-positive women was 5.8% (95% confidence interval [CI], 4.2%-7.8%) for children of HIV-negative women and 10.8% (95% CI, 7.6%-15.2%) for children of HIV-positive women. The adjusted meta-regression model explained 51% of the between-study variation in the 25 included risk estimates. Maternal HIV coinfection was the most important determinant of vertical transmission risk (adjusted odds ratio, 2.56 [95% CI, 1.50-4.43]). Additional methodological (follow-up rate and definition of infection in children) and risk factors independently predicted HCV infection and need to be captured and reported by future studies of vertical transmission. Studies assessing the contribution of nonvertical exposures in early childhood to HCV prevalence among children at risk of vertical transmission are needed. Conclusions. More than 1 in every 20 children delivered by HCV chronically infected women are infected, highlighting that vertical transmission likely constitutes the primary transmission route among children. These updated estimates are a basis for decision making in prioritization of research into risk-reducing measures, and inform case management in clinical settings, especially for HIV-positive women in reproductive age.

Original languageEnglish
Pages (from-to)765-773
Number of pages9
JournalClinical Infectious Diseases
Volume59
Issue number6
DOIs
Publication statusPublished - 15 Sep 2014
Externally publishedYes

Fingerprint

Hepacivirus
Meta-Analysis
HIV
Hepatitis C Antibodies
Virus Diseases
Confidence Intervals
Coinfection
Mothers
Case Management
PubMed
Decision Making
Odds Ratio
RNA
Infection
Research

Keywords

  • Infant
  • Infectious disease transmission
  • Mother-to-child transmission
  • Pregnancy
  • Risk factors

ASJC Scopus subject areas

  • Infectious Diseases
  • Microbiology (medical)
  • Medicine(all)

Cite this

Vertical transmission of hepatitis C virus : Systematic review and meta-analysis. / Benova, Lenka; Mohamoud, Yousra A.; Calvert, Clara; Aburaddad, Laith.

In: Clinical Infectious Diseases, Vol. 59, No. 6, 15.09.2014, p. 765-773.

Research output: Contribution to journalArticle

Benova, Lenka ; Mohamoud, Yousra A. ; Calvert, Clara ; Aburaddad, Laith. / Vertical transmission of hepatitis C virus : Systematic review and meta-analysis. In: Clinical Infectious Diseases. 2014 ; Vol. 59, No. 6. pp. 765-773.
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AB - Background. We conducted a systematic review of estimates of hepatitis C virus (HCV) vertical transmission risk to update current estimates published more than a decade ago. Methods. PubMed and Embase were searched and 109 articles were included. Pooled estimates of risk were generated for children born to HCV antibody-positive and viremic women, aged ≥18 months, separately by maternal human immunodeficiency virus (HIV) coinfection. Results. Meta-analysis of the risk of vertical HCV infection to children of HCV antibody-positive and RNA-positive women was 5.8% (95% confidence interval [CI], 4.2%-7.8%) for children of HIV-negative women and 10.8% (95% CI, 7.6%-15.2%) for children of HIV-positive women. The adjusted meta-regression model explained 51% of the between-study variation in the 25 included risk estimates. Maternal HIV coinfection was the most important determinant of vertical transmission risk (adjusted odds ratio, 2.56 [95% CI, 1.50-4.43]). Additional methodological (follow-up rate and definition of infection in children) and risk factors independently predicted HCV infection and need to be captured and reported by future studies of vertical transmission. Studies assessing the contribution of nonvertical exposures in early childhood to HCV prevalence among children at risk of vertical transmission are needed. Conclusions. More than 1 in every 20 children delivered by HCV chronically infected women are infected, highlighting that vertical transmission likely constitutes the primary transmission route among children. These updated estimates are a basis for decision making in prioritization of research into risk-reducing measures, and inform case management in clinical settings, especially for HIV-positive women in reproductive age.

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