Hepatitis C in injecting drug-using women during and after pregnancy.
BACKGROUND
A high proportion of female injecting drug users (IDU) have evidence of hepatitis C virus (HCV) infection. We undertook a prospective study of patients attending a clinic for pregnant IDU to determine the impact of pregnancy on the course of HCV infection and whether pregnancy is affected by HCV infection.


METHODS
One hundred and thirty-one IDU were recruited and followed up with liver function tests, HCV serology and HCV-RNA tests.


RESULTS
Of 131 patients, 125 had HCV antibodies (anti-HCV positive) at delivery, and of these 62% were HCV-RNA positive. The anti-HCV-negative women were younger and had a shorter duration of drug use than the anti-HCV-positive women. There were no differences between viraemic and non-viraemic women with respect to age, ethnicity, duration of injecting drug use, methadone maintenance dose, hepatitis B exposure or reported high-risk behaviour. Alanine aminotransferase (ALT) levels were higher and the proportion with ALT > 55 IU/L higher in viraemic women. Viraemia persisted in all 55 women who were viraemic at term. Eleven had an ALT flare post-partum that was unrelated to viral load and was clinically unsuspected. Four had concurrent elevated gamma-glutamyltranspeptidase and were considered to be drinking alcohol at hazardous levels. Four of 23 women who were HCV-RNA negative at term became positive during follow up.


CONCLUSIONS
Pregnancy does not adversely affect the course of hepatitis C. A modest rebound in ALT levels, but not HCV-RNA, occurs after delivery in some viraemic women. This supports the theory that immune mechanisms rather than direct viral cytopathology are involved in hepatocyte injury during HCV infection. Hepatitis C infection did not influence pregnancy complications and outcomes.
Latt
N C
NC
Drug and Alcohol Department, The AW Morrow Gastroenterology and Liver Centre, and University of Sydney, NSW, Australia.
Spencer
J D
JD
Beeby
P J
PJ
McCaughan
G W
GW
Saunders
J B
JB
Collins
E
E
Cossart
Y E
YE
D000328:Adult; D016022:Case-Control Studies; D005260:Female; D006526:Hepatitis C / Q000175:diagnosis / Q000453:epidemiology* / Q000635:transmission; D006801:Humans; D008111:Liver Function Tests; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000821:virology*; D011256:Pregnancy Outcome / Q000453:epidemiology; D011446:Prospective Studies; D012307:Risk Factors; D015819:Substance Abuse, Intravenous; D014766:Viremia / Q000453:epidemiology / Q000821:virology