Literature review for - Flourish Paediatrics

Hepatitis C and HIV co-infected mothers?
Draft Evidence Statement
Draft Grade
Component Rating Notes
Evidence Base
Consistency
Clinical impact
Generalisability
Applicability
Hepatitis C mothers co-infected with HIV are at an
increased risk of transmitting Hepatitis C through
breastmilk
D
Satisfactory 3 studies [ 2 narrative review, 1 prospective analysis
(30)]
Satisfactory All studies documented that Hepatitis C/HIV coinfected
mothers that breastfed were at an increased risk
of transmitting Hepatitis C to their infant than those that
bottle fed.
Satisfactory Odds ratio from European Pediatric Hepatitis C
Network study was 6.41 (1.25,32.94) for the risk of
transmitting Hepatitis C through breastfeeding vs.
formula feeding in Hepatitis C/HIV co-infected mothers
Satisfactory The majority of studies were conducted on developed
countries in Europe
Satisfactory Results are applicable to Australian women
(European Pediatric Hepatitis C Network 2001; Pembrey, Newell et al. 2005; Airoldi and
Berghella 2006)
The studies included in the body of evidence statement are shown in the Table below
There is no evidence demonstrating an increased risk of HCV transmission in HIV-negative
women who breastfeed. Although HCV has been detected in small amounts in the colostrum
and breast milk, the amount of HCV/RNA present is too low to infect the newborn and would
be easily inactivated by the infant’s gastric juices (Airoldi and Berghella 2006). The majority
of studies that have reported no association between type of infant feeding and mother-tochild
HCV transmission have had relatively small sample sizes, although an effect of
breastfeeding has not been observed in larger studies (Pembrey, Newell et al. 2005). The
adjusted odds ratio for breastfeeding was 0.95 (95% CI 0.58–1.40, P= 0.74) in the Italian
multi-centre study and 1.52 (95% CI 0.35–5.12, P= 0.5) in the UK/Ireland study. There was
no effect of breastfeeding among 916 women with only HCV infection in the European
Pediatric Hepatitis C Network (EPHN) retrospective analysis. The recent EPHN prospective
study also showed no effect among women with only HCV infection (AOR = 0.92, 95% CI
0.50–1.70, P= 0.80) (Pembrey, Newell et al. 2005).
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