MTCT of HCV among HIV/HCV-co-Infected Women
Claudia Checa Cabot*1, S Stoszek2, J Quarleri3, S Ivalo1, M Peixoto4, M Losso1, J Pilotto5, H Salomon3, L Sidi6, and J Read7
1Hosp Gen de Agudos Jose Maria Ramos Mejia, Buenos Aires, Argentina; 2Westat, Rockville, MD, US; 3Ctr Nacional de Referencia para el SIDA, Univ de Buenos Aires, Argentina; 4Hosp Femina, Porto Alegre, Brazil; 5Hosp Geral de Nova Iguaçu and Lab de AIDS e Imunologia Molecular, Inst Oswaldo Cruz, Rio de Janeiro, Brazil; 6Hosp Federal dos Servidores do Estado, Rio de Janeiro, Brazil; and 7Natl Vaccine Prgm Office, Occupational Safety and Hlth Admin, DHHS, Washington, DC, US
Background: MTCT is the primary mode of pediatric hepatitis C virus (HCV) acquisition. Although maternal HIV co-infection has been associated with increased MTCT of HCV, most studies were performed in the pre-HAART era and few have been conducted in Latin America. Co-infected mothers with uncontrolled HIV may be more likely to transmit HCV.
Methods: The NISDI Perinatal (2002 to 2008) and LILAC (2008 to current) prospective observational cohorts enrolled HIV+ pregnant women and their infants in Argentina, the Bahamas, Brazil, Jamaica, Mexico, and Peru. This sub-study examined mothers with HCV test results and their live-born, singleton infants returning for a 6-month postnatal visit by December 31, 2008. All women with HCV antibodies (anti-HCV) or with CD4 counts (cells/mm3) <200 were tested for HCV RNA. HCV genotype and viral load (copies/mL) were assessed in RNA+ individuals. Infant HCV infection was defined as positive HCV RNA results at 2 visits.
Results: Of 1042 enrolled women, 739 (71%) met inclusion criteria: 70 were HCV infected and 669 were uninfected; 67 (9%) tested anti-HCV+; 44 (66%) of the 67 were HCV RNA+; 3 (4.4%) of 68 anti-HCV– women with CD4 counts <200 tested HCV RNA+. Of 70 HCV+ women, 47 were viremic; 29 (62%) had HCV genotype 1, 1a, or 1b; 9 (19%) had genotype 3a; and 9 could not be typed. Most (74%) HCV viremic women had HIV viral loads <1000 at delivery. Factors associated with maternal HCV infection included unemployment (odds ratio 2.58, 95%CI 1.16 to 5.75), tobacco or marijuana use during pregnancy (1.73, 95%CI 1.01 to 2.97; 3.88, 95%CI 1.34 to 11.23), enrollment HIV viral load ≥10,000 (2.27, 95%CI 1.27 to 4.06), HIV clinical disease stage C (2.12, 95%CI 1.02 to 4.42), and abnormal ALT or AST (4.24, 95%CI 1.59 to 11.33; 11.98, 95%CI 5.29 to 27.16). HCV+ women had lower mean CD4 and platelet counts, and higher HIV viral loads at study enrollment (p <0.05). Of 47 infants born to HCV viremic women, 2 (4.3%, 95%CI 0.5% to 14.5%) were HCV+ and 2 were HCV-indeterminate (tested RNA positive at only 1 visit). All mothers of HCV RNA+ infants had HIV viral loads <1000 and CD4 counts >200 at delivery.
Conclusions: MTCT of HCV among HIV/HCV-co-infected women with controlled HIV may be lower than previously reported in other co-infected populations. Further data from populations with at least 18 months of infant follow-up are needed.