[Rationale for a trial of prevention of perinatal transmission of hepatitis C via specific immunoglobulins].
Vertical transmission of the HCV infection is asymptomatic, occurring in 0-25% of infants born to viremic mothers in Europe. Nowadays, the only preventive measure in to advise against breastfeeding. Favourable conditions for a seroprophylaxis trial in neonates at risk are the low viral charge and the absence of former replication or integration. Several impediments to a randomized-controlled trial should be considered: Epidemiological: paucity of recruitment; low risk of transmission; possible antenatal transmission in cases of high maternal viremia; risk for intrafamilial transmission. Methodological: complex randomization of the study groups (genotyping, quantitative PCR, activity of mothers' diseases, modes/durations of delivery and feeding). Ethical: a direct individual benefit is not clearly established; should viremic mothers be allowed to breast feed their babies in the absence of prophylaxis? the risk of the emergence of mutants or quasi-species of the transmitted hepatitis C virus in neonates; the origin and selection of seropositive plasma donors.
Soulié
J C
JC
Centre d'hémobiologie périnatale, Hôpital Jean-Verdier, Bondy.
D001942:Breast Feeding; D006526:Hepatitis C / Q000453:epidemiology / Q000276:immunology / Q000635:transmission*; D018937:Hepatitis C Antibodies / Q000032:analysis; D006801:Humans; D007136:Immunoglobulins / Q000032:analysis*; D007231:Infant, Newborn / Q000276:immunology*; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D015995:Prevalence; D016032:Randomized Controlled Trials as Topic
D018937:Hepatitis C Antibodies; D007136:Immunoglobulins
Bases décisionnelles d'un essai de prophylaxie de la transmission périnatale de l'hépatite C par immunoglobulines spécifiques.