Background:  Approximately 14% (range 5 to 36%) of HIV/HCV-co-infected pregnant women transmit HCV to their infants, however, there are no standard guidelines for follow-up of HCV/HIV-co-exposed infants. This study was undertaken by the New Jersey Statewide Family Centered HIV Care Network to determine seroprevalence of HCV in HIV-infected women and to develop guidelines for follow-up of their infants.

Methods:  Between January 1, 2001 and June 30, 2003, all infants born to HIV-infected women within this network were evaluated for HCV infection and prospectively followed as per a predetermined protocol. In addition to HCV antibody testing at 6 to 18 months of age, this protocol recommended HCV RNA PCR test at 1 to 2 months of age in all HCV-exposed infants as the early screening test for HCV infection.

Results:  We enrolled in the study 301 infants born to 300 HIV-infected women. Of the 300 HIV-infected women, 31 (10.3%) were co-infected with HCV. The HIV risk factors in the co-infected women were as follows:  17 (54.8%) injecting drug use; 8 (25.8%) heterosexual conduct; and 6 (19.4%) unknown HIV risk. We evaluated 32 infants born to 31 HCV-infected women, of which infants 28 were tested for HCV RNA between ages 7 days and 17 months (mean age of 4 months). Overall, 22 (69%) of the 32 HCV antibody positive infants completed the follow up protocol; 4 (12.5%) were diagnosed with HCV infection based on a positive HCV RNA PCR performed between 1.5 and 5 months of age (mean age 3.9 months); and 23 were considered to be HCV uninfected. Of the HCV-uninfected, 17 completed the follow-up protocol; 5 did not complete the protocol but were classified HCV negative based on negative HCV RNA PCR; 1 was considered uninfected based on a single negative antibody test at four months; 3 were lost to follow-up; and 2 infants did not complete the protocol because the family moved away. No infant was found to be HIV infected.

Conclusions:  HCV sero-prevalence rate in HIV-infected women followed in the New Jersey Statewide Family Centered HIV Care Network was 10.3%, a significantly lower rate of co-infection than the estimated 40% co-infection rate determined in other studies. Perinatal HCV transmission rate was 12.5% in this cohort. Compliance with completing the protocol was (69%); 16% were lost to follow-up. Early HCV RNA testing was a useful test for early identification of infected infants in this high-risk population. 

Keywords: Hepatitis; C; Virus