Nucleic Acid Testing for Diagnosis of Perinatally-Acquired Hepatitis C Virus Infection in Early Infancy.

ABSTRACT:

Background

Most U.S. children with perinatal hepatitis C virus (HCV) exposure fail to receive the recommended anti-HCV antibody test at age ≥18 months. Earlier testing for viral RNA might facilitate increased screening, but sensitivity of this approach has not been established. We hypothesized that modern HCV-RNA RT-PCR platforms would adequately detect infected infants.

Methods

Nationwide Children's Hospital electronic health records from 1/1/2008 to 6/30/2018 were reviewed to identify perinatally-exposed infants tested by HCV-RNA RT-PCR at age 2-6 months. Diagnostic performance was determined using a composite case definition: 1) infected children had positive repeat HCV-RNA testing or positive anti-HCV at age ≥24 months; 2) uninfected children lacked these criteria and had negative anti-HCV at age ≥18 months.

Results

During the study period, 770 perinatally-exposed infants underwent HCV-RNA testing at age 2-6 months. Of these, 28 (3.6%) tested positive, and viremia was confirmed in all who underwent repeat testing (n=27). Among 742 infants with negative HCV-RNA results, 226 received follow-up anti-HCV testing at age ≥18 months, of whom 223 tested negative. Three children had low-positive anti-HCV results at age 18-24 months that were negative upon re-testing after age 24 months, possibly indicating waning maternal antibodies. Using the composite case definitions, early HCV-RNA screening demonstrated sensitivity of 100% (87.5%-100%, Wilson-Brown 95% confidence interval) and specificity of 100% (98.3-100%).

Conclusion

Modern HCV-RNA RT-PCR assays have excellent sensitivity for diagnosis of perinatally-acquired infection at age 2-6 months and could aid HCV surveillance given the substantial loss to follow-up at ≥18 months of age.

SUBMITTER: Gowda C 

PROVIDER: S-EPMC8563185 | biostudies-literature |

REPOSITORIES: biostudies-literature