Spontaneous Clearance of Vertically Acquired Hepatitis C Infection: Implications for Testing and Treatment.

Autor:	Ades AE; Population Health Sciences, University of Bristol Medical School, Bristol, United Kingdom., Gordon F; Population Health Sciences, University of Bristol Medical School, Bristol, United Kingdom., Scott K; Medical Research Council Clinical Trials Unit, University College London, London, United Kingdom., Collins IJ; Medical Research Council Clinical Trials Unit, University College London, London, United Kingdom., Thorne C; Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, United Kingdom., Pembrey L; Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom., Chappell E; Medical Research Council Clinical Trials Unit, University College London, London, United Kingdom., Mariné-Barjoan E; Public Health Department, Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Nice, France., Butler K; Children's Health Ireland at Crumlin and Temple Street, Dublin, Ireland., Indolfi G; Meyer Children's Hospital and Department Neurofarba, University of Florence, Firenze, Italy., Gibb DM; Medical Research Council Clinical Trials Unit, University College London, London, United Kingdom., Judd A; Medical Research Council Clinical Trials Unit, University College London, London, United Kingdom.
Jazyk:	angličtina
Zdroj:	Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [Clin Infect Dis] 2023 Mar 04; Vol. 76 (5), pp. 913-991.
DOI:	10.1093/cid/ciac255
Abstrakt:	Background: Current guidelines recommend that infants born to women with hepatitis C virus (HCV) viremia be screened for HCV antibody at age 18 months and, if positive, referred for RNA testing at 3 years to confirm chronic infection. This policy is based, in part, on analyses that suggest that 25%-40% of vertically acquired HCV infections clear spontaneously within 4-5 years. Methods: Data on 179 infants with HCV RNA and/or anti-HCV evidence of vertically acquired infection in 3 prospective European cohorts were investigated. Ages at clearance of infection were estimated taking account of interval censoring and delayed entry. We also investigated clearance in initially HCV RNA-negative infants in whom RNA was not detectable until after 6 weeks. Results: Clearance rates were initially high then declined slowly. Apparently, many infections clear before they can be confirmed. An estimated 65.9% (95% credible interval [CrI], 50.1-81.6) of confirmed infections cleared by 5 years, at a median 12.4 (CrI, 7.1-18.9) months. If treatment were to begin at age 6 months, 18 months, or 3 years, at least 59.0% (CrI, 42.0-76.9), 39.7% (CrI, 17.9-65.9), and 20.9% (CrI, 4.6-44.8) of those treated would clear without treatment. In 7 (6.6%) confirmed infections, RNA was not detectable until after 6 weeks and not until after 6 months in 2 (1.9%). However, all such cases subsequently cleared. Conclusions: Most confirmed infection cleared by age 3 years. Treatment before age 3, if it was available, would avoid loss to follow-up but would result in substantial overtreatment. Competing Interests: Potential conflicts of interest. C. T. is a member of the Infectious Disease in Pregnancy Screening Programme Advisory Board, Public Health England, and reports grants or contracts from the European Commission, Child Health Charitable Incorporated Organisation, Public Health England, Penta Foundation, and ViiV Healthcare via the Penta Foundation, all paid to the institution outside of the submitted work, and payment or honoraria from ViiV Healthcare paid to self. E. C. reports grants or contracts from ViiV Healthcare to the institution via the Penta Foundation outside of the submitted work. I. J. C. reports a Medical Research Council Global Health Trials Development grant and Gilead HCV Elimination competitive grant, both paid to the institution and outside of the submitted work. All remaining authors: No reported conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed. (© The Author(s) 2022. Published by Oxford University Press for the Infectious Diseases Society of America.)
Databáze:	MEDLINE
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