Perinatal infections III: HIV, hepatitis B and hepatitis C in pregnancy

Also known as HIV in pregnancy · Mother-to-child HIV transmission · Hepatitis B in pregnancy · HBsAg positive pregnancy · Hepatitis C in pregnancy · Blood-borne viruses in pregnancy · Perinatal hepatitis

Exam-exhaustive FRANZCOG reference on the three blood-borne viral infections in pregnancy — HIV (vertical transmission falling from about 25% without intervention to under 1% with combined antiretroviral therapy and a suppressed viral load; the ACTG 076 legacy; viral-load-driven mode of delivery; neonatal prophylaxis; setting-dependent infant feeding), hepatitis B (70 to 90% perinatal transmission if HBeAg-positive; birth-dose vaccine plus immunoglobulin preventing about 94%; tenofovir for high viral load to reach under 1%), and hepatitis C (vertical transmission around 7%; no proven antenatal intervention). ASID Perinatal Infections anchored, globally tagged to MRCOG and ABOG.

high14 referencesUpdated 26 July 202613 min readVerification in progress

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8 MCQs

One-line fellowship answer

Three blood-borne viruses, three different prevention stories. HIV vertical transmission falls from about 25% without intervention to under 1% with combined antiretroviral therapy and a suppressed viral load, with the mode of delivery driven by the viral load and neonatal zidovudine prophylaxis for the infant. Hepatitis B perinatal transmission is 70 to 90% if the mother is HBeAg-positive, but birth-dose hepatitis B vaccine plus immunoglobulin within 12 to 24 hours prevents about 94% of infections, and adding tenofovir in the third trimester for a high viral load reduces transmission to under 1%. Hepatitis C transmits vertically in about 7% of pregnancies, has no vaccine and no proven antenatal intervention, and is treated postpartum with direct-acting antivirals.^[1]^[2]^[5]^[11]

A 26-year-old books at 12 weeks. Her HIV screening is positive, her HBsAg is positive, and she asks whether she can breastfeed. Three answers, each with a different evidence base, and the registrar who holds the combined prevention plan passes the station. This topic is the three answers, organised by virus and by the transmission rate each can be driven down to.^[1]^[5]^[11]

Overview and definition

These three viruses share a route — blood and bodily fluids — and a destination — the infant — and differ on the prevention lever. HIV is driven to under 1% by antiretroviral suppression. Hepatitis B is driven to under 1% by birth-dose immunoprophylaxis plus antiviral prophylaxis. Hepatitis C, for now, is not driven down at all in pregnancy. The candidate who knows which lever belongs to which virus, and the number each reaches, holds the topic.^[1]^[5]^[11]

HIV

Transmission ~25% without intervention; under 1% with cART and suppressed viral load
Predominantly intrapartum transmission
Prevention: maternal cART, viral-load-driven mode of delivery, neonatal prophylaxis
Infant feeding: setting-dependent
Landmark: ACTG 076 (zidovudine 8.3% vs 25.5%)

Hepatitis B

Transmission 70 to 90% if HBeAg-positive, 5 to 20% if HBeAg-negative
~90% of infected infants develop chronic infection
Prevention: birth-dose vaccine + HBIG within 12 to 24 h; tenofovir for high viral load
Reaches under 1% with combined immunoprophylaxis and antiviral prophylaxis
Vaccine-preventable; birth-dose coverage is the global gap

Hepatitis C

Vertical transmission around 7% overall
Higher with HIV co-infection
No vaccine, no approved antiviral in pregnancy
No proven antenatal intervention
Treat the mother postpartum with direct-acting antivirals

^[1] ^[2] ^[5] ^[11]

References14Show

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