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Spontaneous Clearance Of Vertically Acquired Hepatitis C Infection: Implications For Testing And Treatment

Ades, AE; Gordon, Fabiana; Scott, Karen; Collins, Intira Jeannie; Thorne, Claire; Pembrey, Lucy; Chappell, Elizabeth; ... Judd, Ali; + view all (2022) Spontaneous Clearance Of Vertically Acquired Hepatitis C Infection: Implications For Testing And Treatment. Clinical Infectious Diseases 10.1093/cid/ciac255. (In press). Green open access

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Abstract

BACKGROUND: Current guidelines recommend that infants born to women with hepatitis C (HCV) viremia are 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 suggesting 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 three 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 are initially high then decline slowly. Apparently, many infections clear before they can be confirmed. An estimated 65.9% (50.1-81.6) of confirmed infections cleared by 5 years, at a median 12.4 (7.1-18.9) months. If treatment began at age 6 months, 18 months or 3 years, at least 59.0% (42.0-76.9), 39.7% (17.9-65.9), and 20.9% (4.6-44.8) of those treated would clear without treatment. In seven (6.6%) confirmed infections, RNA was not detectable until after 6 weeks, and in 2 (1.9%) not until after 6 months. However, all such cases subsequently cleared. CONCLUSIONS: Most confirmed infection clears by age 3 years. Treatment before age 3, if it was available, would avoid loss to follow-up, but would result in substantial over-treatment.

Type: Article
Title: Spontaneous Clearance Of Vertically Acquired Hepatitis C Infection: Implications For Testing And Treatment
Location: United States
Open access status: An open access version is available from UCL Discovery
DOI: 10.1093/cid/ciac255
Publisher version: https://doi.org/10.1093/cid/ciac255
Language: English
Additional information: © The Author(s) 2022. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/).
Keywords: HCV, Hepatitis C virus, over-treatment, spontaneous clearance, vertical transmission
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology > MRC Clinical Trials Unit at UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
URI: https://discovery.ucl.ac.uk/id/eprint/10146916
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