(296) Early postnatal PCR testing in the prediction of perinatal transmission of Hepatitis C Virus (HCV)

Children with perinatal HCV exposure often fail to receive the recommended anti-HCV antibody test at age ≥18 months. Our objective was to evaluate the ability of early postnatal PCR testing to predict perinatal transmission of HCV.

Study Design:

This is a secondary analysis of a multicenter observational study of HCV in pregnancy. Pregnancies were eligible if antibody-positive for HCV. To evaluate the predictive ability of early HCV PCR, only infants with both 2-6-month HCV PCR and ≥18-month HCV antibody or PCR results to determine HCV status were included. The sensitivity, specificity, positive and negative likelihood ratios, and positive and negative predictive values were calculated. Sensitivity is defined as the proportion of children demonstrating anti-HCV antibodies and/or PCR-positive at ≥18 months who were also PCR-positive at 2-6 months. Specificity is defined as the proportion of infants who were anti-HCV negative at ≥18 months and also PCR-negative at 2-6 months.

Results:

Of 772 neonates with perinatal HCV exposure, 333 had data at both 2-6 months and at ≥18 months (Figure). Of those 333 infants, 13 had a positive PCR at 2-6 months, of whom 13 were confirmed HCV-positive at ≥18 months (true positive). 320 infants had a negative PCR at 2-6 months, of whom 318 were confirmed to be HCV-negative (true negative) and 2 infants were HCV-positive (false negative) at ≥18 months. The sensitivity and specificity of early postnatal PCR testing was 86.7% (95% CI 62.1-96.3%) and 100% (95% CI 98.8-1.00), respectively (Table).

Conclusion:

Early testing of HCV RNA may be beneficial to predict infected infants and facilitate linkage to care. The sensitivity and specificity of early PCR testing suggest that this may be a tool for early identification of infants with perinatal acquisition of HCV.