50 Vertical HCV Transmission in HIV-HCV Coinfected Mothers is Influenced by Nevirapine.

Abstract

INTRODUCTION Vertical transmission of hepatitis C virus (HCV) is greater in infants from pregnant women HCV-HIV (human immunodeficiency virus) coinfected when compared with infants from HCV infected HIV negative mothers. The mechanism of this greater rate of transmission remains unclear. Highly active antiretroviral therapy immune restoration has been implicated in potential adverse effects such as severe presentation of HCV disease. OBJECTIVE to determine the HCV vertical transmission rate from HCV-HIV coinfected mothers, in correlation with antiretroviral treatment. METHODS 18 coinfected pregnant women and their infants were studied. HIV status (viral load, CD4, CD8), antiretroviral treatment, HCV-RNA viral load were analysed in the mothers early in pregnancy and closest to delivery. HCV-RNA viral load was determined in the newborns at birth, 15 days, 1, 2, 5 and 8 months. Vertical transmission was defined as two positive determinations in the newborn. RESULTS During the pregnancy we found a significant decrease of HIV viral load (p<0.01) and increase of CD4 (p<0.05) and HCV viral load (p<0.05). HCV vertical transmission rate was 22%. It was not related to mother's age, coinfection duration, gestational age and birth weight neither to CD4, CD8, HIV and HCV viral load during the pregnancy. Different treatment protocols were used: NRTI (AZT, 3TC, D4T, DDC, DDI), NRTI + IP (RTV), NRTI + NNRTI (NVP). Vertical transmission was not influenced by the number of drugs, neither by NRTI or IP treatment. Only mothers treated with NVP transmitted HCV (transmission rate 50 % (p< 0.05). All the infants HCV infected had HCV viral load negative at birth and at 15 days of life. CONCLUSION Nevirapine strongly influenced the vertical transmission of HCV from coinfected mothers. Vertical transmission was not related to maternal HCV viral load. All infected infants were negative at birth, suggesting the presence of a virus reservoir.