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Recommendations from the AASLD/IDSA advise that all children born to mothers with HCV should be tested for HCV infection. The recommended approach is HCV Ab testing at or after 18 months of age. Given this recommendation, it is not surprising to see that many infants are not being tested, because it is challenging to maintain that linkage to care and communication between obstetricians and pediatricians so that the pediatrician remembers to test the child at 18 months of age.
Children who test positive for the HCV Ab at 18 months of age should undergo HCV RNA testing after 3 years of age to confirm whether they have chronic HCV infection. In addition, and of importance, siblings of children with chronic HCV infection acquired by MTCT should also be tested. My personal recommendation is that all children of mothers with HCV during pregnancy should be tested for HCV infection—not just the infant that is born from the current pregnancy, but also any older children born from the same mother.
Generally speaking, the AASLD/IDSA guidelines do not strongly encourage screening using HCV RNA. It can be considered as early as 2 months of age, but optimal timing is not yet clearly defined.
Are we actually doing a good job in testing children born to mothers with HCV? This study from the Philadelphia Department of Public Health evaluated follow-up of children born to mothers with HCV. The results are concerning: Among > 500 eligible infants, only 84 (or < 20%) were actually tested for HCV infection.
The importance of these data is reflected in the potential outcomes of HCV infection from MTCT discussed earlier: These children may have progression of liver disease, decreased quality of life, and increased risk of hepatocellular carcinoma without their parents knowing that they have HCV.
DAA treatment is now approved for children as young as 3 years of age. The current AASLD/IDSA recommendation is that if children are identified to have HCV from MTCT, they should be linked to care with an HCV specialist who can ideally initiate antiviral therapy as early as possible (starting at 3 years of age) to avoid long-term complications of HCV.