Mother-to-Child Transmission of HCV among HIV/HCV Co-Infected Women

CHECA CABOT: C; STOSZEK S; QUARLERI J; IVALO S; PEIXOTO M; LOSSO M; PILOTTO J; SALOMON H; SIDI L; READ J

Seattle

Conferencia; 19th Conference on Retrovirus and Opportunistic Infections; 2012

Mother-to-Child Transmission of HCV among HIV/HCV Co-Infected Women Claudia Checa, Sonia K. Stoszek, Jorge Quarleri, Silvina Ivalo, Mario F. Peixoto, Marcelo Losso, Jose Pilotto, Horacio Salomon, Leon C. Sidi, Jennifer S. Read Background: Mother-to-child transmission (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. Methods: The NISDI Perinatal (2002-2008) and LILAC (2008-current) prospective observational cohorts enrolled HIV- infected pregnant women and their infants in Argentina, the Bahamas, Brazil, Jamaica, Mexico, and Peru. This sub-study examined mothers with available HCV test results and their live born, singleton infants returning for the six month postnatal visit by December 31, 2008. All women with HCV antibodies (anti-HCV) and/or with CD4 cell counts (cells/mm3) <200 were tested for HCV RNA.  HCV genotype and viral load (VL, copies/mL) were assessed in RNA-positive individuals. Infant HCV infection was defined as positive HCV RNA results at two visits. Results: 739 (71%) of 1042 enrolled women met inclusion criteria. 70 were HCV infected and 669 were uninfected. 67 (9%) tested anti-HCV positive; 44 (66%) of the 67 were HCV RNA positive. Three (4.4%) of 68 anti-HCV negative women with CD4 counts <200 tested HCV-RNA positive.  Of 70 HCV-infected women, 47 were viremic. 29 (62%) had HCV genotype 1, 1a, or 1b, 9 (19%) had genotype 3a, and 9 were untypeable.   Most (74%) HCV viremic women had HIV VLs <1000 at delivery. Factors associated with maternal HCV infection included unemployment (Odds Ratio (OR) 2.58 [95% CI: 1.16, 5.75]), tobacco or marijuana use during pregnancy (OR 1.73 [95% CI: 1.01, 2.97]; OR 3.88 [95%CI: 1.34, 11.23]), HIV VL at enrollment ¡Ý 10,000 (OR 2.27 [95% CI: 1.27, 4.06], HIV clinical disease stage C (OR 2.12 [95% CI: 1.02, 4.42]), and abnormal ALT or AST (OR 4.24 [95% CI: 1.59, 11.33]; OR 11.98 [95% CI: 5.29,27.16]). HCV-infected women had lower mean CD4 and platelet counts, and higher HIV VLs 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-infected and 2 were HCV-indeterminate (tested RNA positive at only one visit).  All mothers of HCV RNA positive infants had HIV VL<1000 and CD4 counts >200 at delivery. Conclusions:  MTCT of HCV among HIV/HCV co-infected women with controlled HIV infection may be lower than previously reported in other HIV/HCV co-infected populations.  Further data from populations with at least 18 months of infant follow-up are needed. Character count of abstract body: 2,470 (limit 2,500)