Methods: This is a prospective cohort study done at Cairo University’s antenatal where pregnant women were enrolled and screened for anti-HCV positive antibodies. Those who were positive were tested for viremia with quantitative real-time PCR at baseline and every 3 months for 12 months after delivery. Viremic women were tested for IL28B polymorphism (rs12979860). Women with 2 undetectable viral loads at least 6 months apart including their last visit were considered to have spontaneous HCV clearance. Associations between demographic, obstetrical and HCV risk factors and clearance were assessed. Fisher's exact and Mann Whitney-U tests were used for analysis of categorical and continuous variables, respectively.
Results: Of 2514 pregnant women, 98 had positive anti-HCV antibodies, of whom 54 were HCV viremic. To date, 50 of 54 women both completed their 1-year follow-up and were tested for IL28B. Their mean age was 31.6+5.3 years, with 28 (56%), 15 (30%) and 6 (12%) having CC, CT and TT polymorphisms, respectively. Of those, 36/50 (72%) had a significant (>0.5 log) drop in their HCV viral load within the first 3 months after delivery, 58% of whom had a CC genotype, and 7 had complete HCV clearance (14%) by their 12-month visit. Among those who cleared, 6 had CC genotype (86%), 1 had CT, and none had TT. Other than IL28B status, there were no other predictors for viral clearance. Age, baseline viral load, obstetrical history (delivery method, previous C-section, number of pregnancies, abortions, premature, full-term and live births) and HCV risk factors (history of jaundice, liver disease, surgery, blood transfusion, needle-sticks, tattoos, injections, endoscopy, dialysis , dental work or healthcare sector employment ), were not associated with viral clearance (p>0.05).
Conclusion: IL28B-CC genotype was the best predictor for a significant drop in viral load in the immediate postpartum period, and for viral clearance in pregnant women with chronic HCV. HCV-infected pregnant women should be re-tested after delivery, particularly if they have an IL28B-CC genotype.
R. Jhaveri, MedImmune: Grant Investigator , Research grant
merck: Grant Investigator , Research grant
Genentech: Scientific Advisor , Consulting fee
D. Saleh, None
M. Ehab, None
S. Sharaf, None
F. El-Mougy, None
L. Abdelsalam, None
A. Aboulnasr, None
H. El-Ghazaly, Merck: Investigator , Research support