Resumen de Estudio retrospectivo de factores de riesgo de transmisión vertical de infección por virus hepatitis C
P. Madurga-Revilla, Marta Aguar, R.A. Pereda Pérez, Vicent Modesto y i Alapont, A. Montañés Sánchez, E. Torres Martínez, M. Brugada, S. León Cariñena
Introduction Despite the low prevalence of paediatric HCV infection and its initial mild clinical expressiveness, chronic infection could progress into cirrhosis and/or hepatocarcinoma. It is essential to control vertical transmission. Recent studies show that up to 50% of transmissions occur within the uterus.
Material y methods A retrospective study was conducted on 17 cases of (HepatitisC virus) HCV infection registered over a period of 8 years. Vertical transmission risk factors were analysed, in order to introduce primary prevention.
Results Only parenteral drug addiction significantly increased the rate of HCV transmission; HIV co-infection was not a confounding factor. HCV viremia, HIV co-infection, liver dysfunction and/or duration of the infection did not appear to affect the rate of transmission. Caesarean section, amniocentesis and internal monitoring may be risk factors (not statistically significant), but not prolonged vaginal delivery after amniotic membrane rupture. Breastfeeding showed protection.
Conclusions The effect of viremia on the risk of transmission is not clearly established, despite the importance usually attributed. Lack of viremia does not discount the risk of transmission, due to viral RNA detection can be intermittent, so it should be interpreted cautiously. Immunosuppression secondary to HIV co-infection implies a higher risk of transmission, but this effect decreases by improving immune competence by antiretroviral treatment. With regard to the birth characteristics, time after the rupture of membranes has not shown being a risk factor; being the caesarean not advisable as a good alternative to finish the pregnancy. Breastfeeding does not increase the risk, even it can be protective. This results would be justified by the low viral content of milk, its inactivation by gastric pH and its immunological benefits.
Given that retrospective studies results are limited, prospective studies need to be carried out in order to improve the understanding of the role of possible risk factors and to provide a clear preventive guidelines. At the moment it is essential to control all the children born of mothers with HCV infection.
