PROPHYLACTIC MEASURES AGAINST INFECTION WITH HEPATITIS C VIRUS AND HIV IN INFANTS
DOI:
https://doi.org/10.6016/ZdravVestn.2288Keywords:
HCV and HIV infection, fetus, routes and frequency of infections, effectiveness of prophylactic measuresAbstract
Background. The World Health Organization estimates that every year more then 500,000 infants get infected with human immunodeficiency virus (HIV) and 10,000– 60,000 with hepatitis C virus (HCV) worldwide.
Rapid and early diagnosis of HCV and HIV infection in exposed infants is rendered difficult because of transplacental passage of maternal IgG antibodies to the virus that are present in infants up to 18 months of age. Mother-to-infant transmission of HCV is comparatively uncommon. Furthermore, chronic hepatitis C does not appear to worsen the outcome of pregnancy or predispose fetal abnormalities.
The rate of mother-to-infant transmission is 4 to 7% per pregnancy in women with HCV viremia. Perinatal infection with HCV is usually asymptomatic. Concomitant infection in pregnant women with HIV increases the rate of transmission of HCV infection 4 to 5 fold. Cesarean section is not recommended and current available medications against HCV infection are contraindicated because of fetal toxicity. Breast-feeding poses no relevant risk of HCV transmission.
Conclusions. Perinatal transmission of HIV from mother to child accounts to 5 to 10% of acquired HIV infections worldwide. It is by far the major source of infection and represents more that 90% of all infections in children. Transmission of HIV occurs either before birth, during delivery or through breastfeeding.
Recently, zidovudine and some other antiretrovirals administered during pregnancy, at delivery, and in the first 6 weeks of life to the infant have reduced transmission by more than two thirds (from 25 to less than 5%). The experts have also recommended elective cesarean section and dissuaded HIV positive mothers from breastfeeding.
Experts must also test strategies to further decrease the risk for perinatal HCV and HIV infection. Significant progress in the area of new safe and effective vaccines is eagerly expected.
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