Hepatitis C Virus Viral Load And Mother-To-Child Transmission: a Systematic Review and Meta - Analysis

Background: Hepatitis C virus (HCV) infection is increasing among pregnant women own to the opioid epidemic, and mother-to-child transmission (MTCT) was considered to be the leading cause of hepatitis C in the future. Thus, our aim of this study was to assess the association of maternal HCV viral load and human immunodeficiency virus (HIV) coinfection with the risk of MTCT in pregnant women infected by HCV. Methods: We performed a literature searching using MEDLINE, EMBASE, CENTRAL, SCIE, CPCIS, SCOPUS, LILACS and WHO Global Index Medicus from inception to 1 March 2021. Manuscripts were included if they reported the incidence of HCV MTCT. Pooled effect estimates were obtained by using random-effects model and Holm-Bonferroni correction was performed for multiple pooled associations. Results: a total of 26 studies involving 4491 newborns with maternal HCV infected were identified. Pregnant women with HCV viremia had increased risk of MTCT (odds ratio [OR]: 8.14, 95% confidence interval [CI]: 4.62-14.31) compared with those with negative HCV-RNA. Multiple-subgroup analysis showed HCV viremia/HIV+ group experienced the highest risk for HCV MTCT and then HCV viremia mono-infected group; HCV-RNA negative women experienced the lowest risk for HCV MTCT. Among HCV viremia women, elevated risk of MTCT was found in subjects with viral load ≥6 log copies/ml as compared with those with viral load < 6 log copies/ml (OR=4.93, 95% CI: 2.38-10.21). Conclusions: The HCV MTCT incidence is increased in pregnant women with detectable HCV viremia, and is even higher in those with viral load ≥6 log copies/ml. HIV coinfection further increases the risk of HCV MTCT.