Chronic Viral Infections and Invasive Procedures: Risk of Vertical Transmission and Current Recommendations

Abstract

The risk of transmission of human immunodeficiency virus (HIV), hepatitis B (HBV) and hepatitis C virus (HCV) during invasive procedures may not be negligible, although it has been poorly assessed. The risk of hepatitis B transmission during amniocentesis seems to be low, but it may be increased in women with a positive HBeAg. HCV transmission risk cannot be established because evidence is lacking. No information exists about other invasive procedures in such infections. An increased risk of vertical transmission following an invasive procedure was suggested in HIV infection, but amniocentesis seems to be safe when performed under highly active antiretroviral treatment, with a low viral load and when avoiding placental passage. International guidelines do not clearly define policies to screen for maternal blood-borne virus infection during invasive procedures. Nevertheless, serological status should be assessed in all cases and parents should be aware of the existing evidence for transmission risk. Transplacental amniocentesis should always be avoided.

Prevention and Management of Viral Hepatitis in Pregnancy

“…58 Evidence is lacking regarding the risk of transmission after amniocentesis, although no evidence suggests an increased risk. 65 If amniocentesis is performed, traversing the placenta should be avoided. Vertical transmission has been shown to be higher after premature rupture of membranes.…”

Management of HBV in Pregnancy

“…It is theoretically possible to transmit infection through amniocentesis; however, the overall risk is low, especially in those with low HBV DNA [27]. One case-control study suggests a possible increase in MTCT rates in women with high viral loads undergoing amniocentesis (among women with ≥7 log copies/ml: vertical transmission 50 vs 4.5 % in controls without amniocentesis, p=0.006) [28]; however, additional studies are warranted before treatment recommendations can be made.…”

11.0 References

“…There are no studies and few case reports in the HAART era reporting on chorionic villus sampling or cordocentesis [217]. For evidence relating to choice of ART to reduce transmission risk associated with amniocentesis, see Section 5.4 on late presentation.…”