Viral load in HCV RNA-positive pregnant women

OBJECTIVES: The risk of hepatitis C virus (HCV) infection in the newborn is estimated to be around 5%, but becomes very high in the case of coinfectio n with HIV. One of the main factors associated with the vertical transmissi on of HCV is the viral load. Our objective was to investigate the behavior of HCV viral load during pregnancy in relation to HIV coinfection, liver en zymes, and vertical transmission. METHODS: Three thousand seven hundred forty-eight women seen consecutively in their first trimester of pregnancy were screened for HCV infection. Sixt y-five were found to be anti-HCV+/HCV RNA+ and were followed up with clinic al and serological assessment (i.e., transaminases and quantitative polymer ase chain reaction [PCR] for viral load) in their second and third trimeste rs and 6 months after delivery. All were anti-HIV and hepatitis B surface a ntigen negative. HCV RNA was 12.0 +/- 19.9 x 10(6) copies/ml in the first t rimester and 10.9 +/- 13.3 x 10(6) in the second, but increased to 19.5 +/- 25.1 x 10(6) in the third trimester. Six months after delivery the viral l oad returned to the baseline levels; the changes in viral load did not reac h any statistical significance, however. Transaminases tended toward a redu ction from the baseline during the second and third trimesters, and then an increase in both AST and ALT was recorded 6 months after delivery. However , when the group whose AST/ALT were found abnormal at the first test was co nsidered, no significant chan-es were recorded during the follow-up. The ov erall rate of vertical transmission was 4.6%. CONCLUSIONS: With HCV+ mothers monitoring transaminases during pregnancy is unnecessary, and testing liver enzymes at the beginning of pregnancy is su fficient. Qualitative PCR should be done once during the pregnancy, but any staging of the liver disease should be taken after delivery. Quantitative PCR testing is expensive and pointless. Any decision for elective cesarean section in HCV RNA+ mothers should be confirmed by other studies. (Am J Gas troenterol 2001;96:2751-2754. (C) 2001 by Am. Coll. of Gastroenterology).