Perinatal Transmission of Hepatitis C Virus

Author: Jo Hofmann, MD

Last updated: March 19, 2013

A 26-year-old woman in the second trimester of her first pregnancy is evaluated by her obstetrician for extreme fatigue and pruritis. Her past medical history is unremarkable; she is currently in a monogamous relationship, but describes multiple male sex partners prior to this relationship. Prenatal tests for HIV, syphilis, and hepatitis B surface antigen (HBsAg) are negative. She previously received three doses of hepatitis B vaccine. Her physical examination is unremarkable with the exception of scattered minor excoriations related to what she describes as occasional “unbearable itchiness.” An elevated serum alanine aminotransferase (ALT) prompts further evaluation for liver disease and she is found to have a positive hepatitis C virus (HCV) serum antibody (anti-HCV) and a HCV RNA level of 2.3 million IU/ml, determined by a nucleic acid amplification test (NAAT).

Which of the following is a TRUE statement regarding potential transmission of HCV from the patient to her newborn during the perinatal period?

A Compared with vaginal delivery, elective Cesarean section has been documented as an effective method to decrease vertical HCV transmission. Thus, elective cesarean section is recommended for all pregnant women with HCV infection and a detectable HCV RNA level.
B The risk of vertical HCV transmission is lower in women with HCV infection who are co-infected with HIV than for those women with HCV infection only.
C Controlled trials have demonstrated that treatment of HCV infection with ribavirin (Copegasys or Rebetol) and interferon during pregnancy is safe and effective in reducing vertical HCV transmission.
D Hepatitis C antibody testing of her infant during the first 6 to 9 months after birth may not accurately determine the presence or absence of HCV infection.