In addition, a higher rate of MTCT is seen in mothers who are coinfected and HCV viraemic compared to those who are coinfected and non-viraemic (OR 2.82) as well as to HCV viraemic but HIV-negative (OR 1.97) [,]. Acquisition
of infection of HCV is more likely in infants also becoming infected with HIV and vertical transmission of HIV occurs more often from women coinfected with HIV and HCV than from those infected with HIV only (OR 1.82) where a modest association was found with HCV VL . Numerous studies have shown that the height of the HCV VL correlates with the risk of HCV MTCT and it is likely there is a linear relationship between VL and transmission as for HIV [,]. Invasive obstetric procedures, internal fetal monitoring, prolonged ROMs and female infant sex have also been associated with transmission but breastfeeding and CS do not pose Epigenetics inhibitor an additional risk in mono-infected mothers [,]. Effective Belinostat nmr HAART significantly reduces the rate of HCV transmission, possibly by reducing HCV viraemia [,]. No correlation with HCV genotype or interleukin-28 polymorphisms and transmission has been identified [,,]. Both intrauterine and intrapartum infection probably occur, but the relative contribution of each is uncertain.
However, approximately one-third of neonates are HCV-viraemic at birth suggesting acquisition in utero . 6.2.1 On diagnosis of new HCV infection, confirmation of HCV viraemia with quantitative VL and genotype, assessment of hepatic inflammation and function and concomitant liver disease should be performed. Grading: 1C 6.2.2 LFTs should be repeated at 2 weeks after commencing HAART to detect evidence of hepatotoxicity or IRIS and then monitored throughout pregnancy and postpartum. Grading: 1C In a pregnant HIV-positive woman newly diagnosed with HCV, in addition to referral to the local designated specialist, baseline investigations including the presence (HCV RNA) and level of the virus (HCV VL), genotype and subtype, degree of inflammation and synthetic
function (ALT, aspartate transaminase, albumin, INR), assessment of fibrosis, and exclusion of additional causes of liver disease (e.g. haemochromatosis, autoimmune hepatitis) are indicated. Additionally, patients should next be assessed for the need for HAV (HAV IgG antibody) and HBV (HBsAb) immunization, as well as for HBV coinfection (HBsAg). Fibroscan is contraindicated during pregnancy so that where there is suspicion of advanced liver disease, liver ultrasound scanning should be performed. It is important where cirrhosis is found to be present that there is close liaison with the hepatologist because of a significantly increased rate of complications . However, in the absence of decompensated disease, most women with cirrhosis do not have obstetric complications from their HCV infection.