Elsevier

Journal of Hepatology

Volume 31, Issue 3, September 1999, Pages 416-420
Journal of Hepatology

Detection of hepatitis C virus RNA (HCV RNA) in amniotic fluid: a prospective study

https://doi.org/10.1016/S0168-8278(99)80031-2Get rights and content

Abstract

Background/Aims: Mother-to-infant transmission of hepatitis C virus (HCV) has been reported, but the transmission route is unknown. The aim of our study was to detect HCV RNA in amniotic fluid of pregnant women seropositive for HCV.

Methods: Twenty-two HCV seropositive women were included in the study (median age: 39 years). An amniocentesis was performed in all patients during the 4th month of pregnancy. Sixteen women also tested positive for HCV RNA in serum. The range of HCV RNA titers was 0.3 to 15.1×106 Eq/ml (Quantiplex HCV RNA 2.0 Assay, Chiron Diagnostics). Of these 16 viremic patients, four had an anterior placenta, ten had a posterior placenta and the position of the placenta was not determined in two cases. PCR (Amplicor HCV, Roche Diagnostics) was used to detect HCV RNA in the amniotic fluid. We also studied 11 HCV seronegative women as a control group.

Results: In the viremic group (n=16), HCV RNA was detected once in amniotic fluid. The positive specimen was collected from a patient with an HCV RNA serum value equal to 1.1×106 Eq/ml. The placenta was in an anterior position. A PCR inhibitor was detected in one case. No HCV RNA was detected in the amniotic fluid of six seropositive non-viremic patients, nor in the control group. Serum HCV RNA was negative in the ten children tested. The woman whose amniotic fluid contained HCV RNA was the mother of one of them.

Conclusions: HCV RNA detection in amniotic fluid is rarely positive. The anterior position of the placenta in the only positive detection cannot rule out contamination of the amniotic fluid during the transplacental amniocentesis.

Section snippets

Patients

Thirty-three pregnant women were enrolled from June 1996 to August 1998. Twenty-two of these women were HCV seropositive and 11 were HCV seronegative (control group). The HCV-positive patients ranged from 25 to 42 years (median: 39 years). Thirteen patients had a posterior placenta and seven had an anterior placenta. The position of the placenta was not determined in the remaining two cases. An amniocentesis was performed in the early second trimester of pregnancy to detect karyotype

Detection and quantification of HCV RNA in maternal serum

HCV RNA was detected in 16 HCV-antibody-positive patients. Serum genomic titers, measured by Quantiplex HCV RNA technique were 0.3 to 15.1×106 Eq/ml (median: 2.5×106 Eq/ml). No HCV RNA was found in six of the HCV-seropositive women.

Detection and quantification of HCV RNA in amniotic fluid

All of the 33 amniotic fluids studied had a clear aspect. HCV RNA was detected in the amniotic fluid of one of the 16 viremic patients. HCV RNA titer in the amniotic fluid measured by the Monitor technique was 230 copies HCV RNA/ml. The serum genomic titer was 1.1×106

Discussion

The vertical transmission risk of HCV from mother to infant has been well documented 12., 13., 14., 15. but the mode of transmission is unknown. Virologic and obstetrical factors could influence transmission, but their relative contributions are difficult to assess. Two viral factors seem to influence the maternal-fetal transmission, and these are serum HCV RNA titer and HIV coinfection. Several studies have shown that the risk of transmission is correlated with the HCV RNA titers in the mother

Acknowledgements

The authors thank Brigitte Méraud for her excellent technical assistance.

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