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2215. Polymerase Chain Reaction (PCR) for Detection of Vertically Acquired Hepatitis C Virus (HCV) Infection in Early Infancy

BACKGROUND: Many children born to HCV-infected mothers in the U.S. never receive recommended anti-HCV antibody (Ab) screening at age ≥ 18 months. Earlier testing by HCV-RNA PCR might facilitate increased screening, though prior studies using older PCR assays reported unacceptably low sensitivity of...

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Autores principales: Honegger, Jonathan, Crim, Linda, Gowda, Charitha, Sanchez, Pablo J
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6254897/
http://dx.doi.org/10.1093/ofid/ofy210.1868
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author Honegger, Jonathan
Crim, Linda
Gowda, Charitha
Sanchez, Pablo J
author_facet Honegger, Jonathan
Crim, Linda
Gowda, Charitha
Sanchez, Pablo J
author_sort Honegger, Jonathan
collection PubMed
description BACKGROUND: Many children born to HCV-infected mothers in the U.S. never receive recommended anti-HCV antibody (Ab) screening at age ≥ 18 months. Earlier testing by HCV-RNA PCR might facilitate increased screening, though prior studies using older PCR assays reported unacceptably low sensitivity of one-time PCR testing in infants. We hypothesized that testing at age 2–6 months using modern blood HCV-RNA PCR platforms with enhanced analytical sensitivity and reliability will adequately detect infected infants. METHODS: Medical records of vertically exposed infants tested for HCV-RNA at age 2–6 months at Nationwide Children’s Hospital from January 1, 2008 to December 31, 2017 were reviewed. HCV-RNA tests included qualitative (in-house) and quantitative (ARUP reference lab) Cobas Taqman RT-PCR assays (Roche) with lower limits of detection of 1.2–1.9 log(10) IU/mL. Diagnostic performance of early PCR screening was determined using a composite gold standard: (1) infected children had ≥ 2 positive PCRs or persistently positive Ab after age 24 months; (2) uninfected children lacked these criteria and required documentation of a negative Ab at a point after age 18 months. RESULTS: During the study period, 639 vertically exposed infants underwent HCV-RNA testing at age 2–6 months. Of these, 24 (3.8%) tested positive, consistent with prior estimates of the vertical transmission rate. Blood HCV-RNA levels were high at screening (median 6.7 log(10) IU/mL, range 5.2–7.8 log(10) IU/mL), and confirmatory PCR tests were positive in all who had repeat testing (n = 22). Among 615 infants with negative PCR screening, 444 had reached age ≥ 18 months, of whom 144 had undergone Ab testing. Ab tests were negative in 142, while two children had low positive Ab results at 18 months. In both cases, repeat PCR and repeat Ab after age 24 months were negative, suggesting waning maternal Ab rather than true infection. Using the composite gold standard there were 22 true positive, 0 false-positive, 144 true negative, and 0 false negative cases, yielding a sensitivity of 100% (95% CI: 85–100% [Wilson-Brown]). CONCLUSION: These findings demonstrate that modern blood HCV-RNA PCR assays have excellent sensitivity for detecting vertically infected infants as early as 2–6 months of age and may improve HCV surveillance given the substantial number of children lost to follow-up prior to 18 months Ab screening. [Image: see text] DISCLOSURES: All authors: No reported disclosures.
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spelling pubmed-62548972018-11-28 2215. Polymerase Chain Reaction (PCR) for Detection of Vertically Acquired Hepatitis C Virus (HCV) Infection in Early Infancy Honegger, Jonathan Crim, Linda Gowda, Charitha Sanchez, Pablo J Open Forum Infect Dis Abstracts BACKGROUND: Many children born to HCV-infected mothers in the U.S. never receive recommended anti-HCV antibody (Ab) screening at age ≥ 18 months. Earlier testing by HCV-RNA PCR might facilitate increased screening, though prior studies using older PCR assays reported unacceptably low sensitivity of one-time PCR testing in infants. We hypothesized that testing at age 2–6 months using modern blood HCV-RNA PCR platforms with enhanced analytical sensitivity and reliability will adequately detect infected infants. METHODS: Medical records of vertically exposed infants tested for HCV-RNA at age 2–6 months at Nationwide Children’s Hospital from January 1, 2008 to December 31, 2017 were reviewed. HCV-RNA tests included qualitative (in-house) and quantitative (ARUP reference lab) Cobas Taqman RT-PCR assays (Roche) with lower limits of detection of 1.2–1.9 log(10) IU/mL. Diagnostic performance of early PCR screening was determined using a composite gold standard: (1) infected children had ≥ 2 positive PCRs or persistently positive Ab after age 24 months; (2) uninfected children lacked these criteria and required documentation of a negative Ab at a point after age 18 months. RESULTS: During the study period, 639 vertically exposed infants underwent HCV-RNA testing at age 2–6 months. Of these, 24 (3.8%) tested positive, consistent with prior estimates of the vertical transmission rate. Blood HCV-RNA levels were high at screening (median 6.7 log(10) IU/mL, range 5.2–7.8 log(10) IU/mL), and confirmatory PCR tests were positive in all who had repeat testing (n = 22). Among 615 infants with negative PCR screening, 444 had reached age ≥ 18 months, of whom 144 had undergone Ab testing. Ab tests were negative in 142, while two children had low positive Ab results at 18 months. In both cases, repeat PCR and repeat Ab after age 24 months were negative, suggesting waning maternal Ab rather than true infection. Using the composite gold standard there were 22 true positive, 0 false-positive, 144 true negative, and 0 false negative cases, yielding a sensitivity of 100% (95% CI: 85–100% [Wilson-Brown]). CONCLUSION: These findings demonstrate that modern blood HCV-RNA PCR assays have excellent sensitivity for detecting vertically infected infants as early as 2–6 months of age and may improve HCV surveillance given the substantial number of children lost to follow-up prior to 18 months Ab screening. [Image: see text] DISCLOSURES: All authors: No reported disclosures. Oxford University Press 2018-11-26 /pmc/articles/PMC6254897/ http://dx.doi.org/10.1093/ofid/ofy210.1868 Text en © The Author(s) 2018. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Abstracts
Honegger, Jonathan
Crim, Linda
Gowda, Charitha
Sanchez, Pablo J
2215. Polymerase Chain Reaction (PCR) for Detection of Vertically Acquired Hepatitis C Virus (HCV) Infection in Early Infancy
title 2215. Polymerase Chain Reaction (PCR) for Detection of Vertically Acquired Hepatitis C Virus (HCV) Infection in Early Infancy
title_full 2215. Polymerase Chain Reaction (PCR) for Detection of Vertically Acquired Hepatitis C Virus (HCV) Infection in Early Infancy
title_fullStr 2215. Polymerase Chain Reaction (PCR) for Detection of Vertically Acquired Hepatitis C Virus (HCV) Infection in Early Infancy
title_full_unstemmed 2215. Polymerase Chain Reaction (PCR) for Detection of Vertically Acquired Hepatitis C Virus (HCV) Infection in Early Infancy
title_short 2215. Polymerase Chain Reaction (PCR) for Detection of Vertically Acquired Hepatitis C Virus (HCV) Infection in Early Infancy
title_sort 2215. polymerase chain reaction (pcr) for detection of vertically acquired hepatitis c virus (hcv) infection in early infancy
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6254897/
http://dx.doi.org/10.1093/ofid/ofy210.1868
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