Hepatitis C

Question 1

HCV Screening

Answer 1

HCV antibodies

Question 2

Tests if HCV antibody +ve

Answer 2

HCV RNA and LFTs

Question 3

Positive HCV antibodies but negative HCV RNA

Answer 3

• May represent either false positive antibody, past cleared infection, past successful treatment or low level viraemia below assay level detection
• Risk of transmission with RNA -ve mothers is negligible
• Not protected against reinfection (if ongoing RF, retest in third trimester)

Question 4

Risk of perinatal transmission if HCV RNA positive

Answer 4

~5%
No specific risk factor predicts transmission and no specific intervention has been demonstrated to reduce transmission (with the exception of antiretrovirals for women with HIV / HCV coinfection)

Question 5

Management HCV

Answer 5

• Minimise invasive procedures e.g. FSE
• Data on amnio/chorio reassuring but limited, amnio has more data
• No clear evidence than CS reduced transmission

Question 6

Breastfeeding HCV

Answer 6

• No increased risk demonstrated
• Consider pump and dump if nipples cracked and bleeding

Question 7

Antiviral treatment of HCV

Answer 7

• Rx during pregnancy and breastfeeding with direct-acting antivirals currently contradicted (due to lack of data)
• Refer to ID or gastroenterologist for consideration of treatment post-partum

Question 8

Neonatal Management HCV mother

Answer 8

• HCV RNA at or after 3 months
• If neg, test for HCV Ab at or after 18 months and then HCV RNA again if positive
• Positive HCV Ab may be due to lack of maternal clearance
• If either positive refer