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

BACKGROUND: We conducted a systematic review of estimates of hepatitis C virus (HCV) vertical transmission risk to update current estimates published over a decade ago. METHODS: PubMed and Embase were searched and 109 articles included. Pooled estimates of risk were generated for children born to HCV antibody positive and viraemic women, at age 18 months or older, separately by maternal HIV co-infection. 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 and 10.8% (95%CI: 7.6-15.2) for children of HIV-positive women. Adjusted meta-regression model explained 51% of the between-study variation in the 25 included risk estimates. Maternal HIV co-infection 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 non-vertical exposures in early childhood to HCV prevalence among children at risk of vertical transmission are needed. CONCLUSIONS: More than one in every 20 children delivered by HCV chronically infected women is infected, highlighting that vertical transmission constitutes probably 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

• Epidemiology and Determinants of Health
  • Epidemiology
• Population(s)
  • Other
• Co-infections
  • Hepatitis B, C