1,721,142 research outputs found
The management of HCV infected pregnant women and their children European paediatric HCV network
No full textBACKGROUND/AIMS:
As evidence accumulates relating to mother-to-child (vertical) transmission of hepatitis C virus (HCV), it is timely to draw up guidelines for the clinical management of HCV infected pregnant women and their children.
METHODS:
A review of evidence from the European Paediatric HCV Network (EPHN) prospective study of HCV infected women and their children and other published studies. Meeting of EPHN clinical experts to reach a consensus on recommendations for management. Each recommendation was graded according to the level of evidence.
RESULTS/CONCLUSIONS:
Although several risk factors for mother-to-child transmission have been identified, none are modifiable and there are currently no interventions available to prevent vertical transmission of HCV. Data on timing of loss of maternal antibodies and reliability of diagnostic tests inform the optimum follow-up schedule for confirmation or exclusion of infection in children born to HCV infected women. Based on the current evidence, routine antenatal screening for HCV should not be introduced and neither elective caesarean section nor avoidance of breastfeeding should be recommended to HCV infected women to prevent mother-to-child transmission of HCV. HCV/HIV co-infected women should follow existing HIV guideline
Persistence rate and progression of vertically acquired hepatitis C infection.
No full textData were collected from 104 infected children who were followed up from birth for a mean of 49 (range, 6-153) months in 22 European centers, to outline the natural history of perinatal hepatitis C virus (HCV) infection. Fifty-four children were persistently HCV RNA positive, 44 were occasionally positive, and 6 never had detectable viremia. At least 90% of the children had evidence of ongoing infection at the latest analysis. Eighteen children became HCV RNA negative at their last assessments, but 40% of these had high alanine aminotransferase (ALT) concentrations. Infection was asymptomatic in all but 2 children, who developed hepatomegaly. Mean ALT concentrations decreased substantially after the first 2 years of life; 14 children had persistently normal ALT values. Signs of minimal to moderate inflammation were noted in all 20 patients who underwent liver biopsy. Perinatal HCV infection is usually asymptomatic in the first years of life, but the virus persists in most children, even in the absence of elevated ALT activity
Persistence rate and progression of vertically acquired hepatitis C infection. European Paediatric Hepatitis C Virus Infection.
No full textEuropean paediatric hepatitis C virus network. Antenatal hepatitis C virus screening and management of infected women and their children: policies in Europe.
No full textMaternal and infant factors and lymphocyte, CD4 and CD8 cell counts in uninfected children of HIV-1-infected mothers.
No full textIncreased risk of adverse pregnancy outcomes in HIV-infected women treated with highly active antiretroviral therapy in Europe.
No full textEffects of mode of delivery and infant feeding on the risk of mother-to-child transmission of hepatitis C virus.
No full textObjective To investigate the effects of mode of delivery and infant feeding on the risk of mother-to-child
transmission of hepatitis C virus.
Design Pooled retrospective analysis of prospectively collected data.
Sample Data on hepatitis C virus seropositive mothers and their children identi®ed around delivery were sent
from 24 centres of the European Paediatric Hepatitis C Virus Network.
Main outcome measures Hepatitis C virus infection status of children born to hepatitis C virus infected women.
Results A total of 1,474 hepatitis C virus infected women were identi®ed, of whom 503 (35%) were co-infected
with HIV. Co-infected women were more than twice as likely to transmit hepatitis C virus to their children
than women with hepatitis C virus infection alone. Overall 9.2% (136/1474) of children were hepatitis C virus
infected. Among the women with hepatitis C virus infection-only, multivariate analyses did not show a
signi®cant effect of mode of delivery and breastfeeding: caesarean section vs vaginal delivery OR 1.17,
P 0.66; breastfed versus non-breastfed OR 1.07, P 0.83. However, HIV co-infected women delivered
by caesarean section were 60% less likely to have an infected child than those delivered vaginally (OR 0.36,
P 0.01) and those who breastfed were about four times more likely to infect their children than those who did
not (OR 6.41, P 0.03). HIV infected children were three to four times more likely also to be hepatitis C
virus infected than children without HIV infection (crude OR 3.76, 95% CI 1.89±7.41).
Conclusions These results do not support a recommendation of elective caesarean section or avoidance of
breastfeeding for women with hepatitis C virus infection only, but the case for HIV infected women undergoing
caesarean section delivery and avoiding breastfeeding is strengthened if they are also hepatitis C virus
infected
Maternal and infant factors and lymphocyte, CD4 and CD8 cell counts in uninfected children of HIV-1-infected mothers
Full text linkObjective: To evaluate the effects of antiretroviral treatment (ART) for mother-to-child transmission of HIV and infant/maternal characteristics on total lymphocytes (TLC) and lymphocyte subsets in uninfected children of HIV-1-infected mothers.
Design: The European Collaborative Study followed 1663 uninfected children from birth until at least 8 years of age using a standard protocol.
Methods: Smoothers (running medians) illustrated patterns of immune markers over age by ART exposure and race. Associations between lymphocyte parameters and maternal/infant characteristics were quantified in linear regression analyses using z-scores obtained after modelling log(10)-transformed TLC, CD4 and CD8 cell counts using the LMS method. Cox proportional hazard models assessed time to TLC, CD4 and CD8 cell counts below the defined cut-off. Covariates included prematurity, gender, race, drug withdrawal and ART exposure.
Results: Overall, black children had lower TLC, CD4 and CD8 cell counts than white children, and an increased risk of TLC, CD4 and CD8 cell counts below the cut-off. ART exposure was associated with TLC levels (but not with TLC below the cut-off for lymphopenia), with reduced CD4 cell counts in the first year of life, and with reduced CD8 cell counts until at least 8 years of age. Duration and intensity of ART exposure was associated with TLC levels.
Conclusion: The effect of ART exposure in fetal and early life on TLC and CD8 cell counts was prolonged until at least 8 years. These results add to the growing list of adverse effects associated with ART used as prevention of mother-to-child transmission of HIV
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