Hashem M, et al. - In view of previous findings that postpartum hepatitis C viral (HCV) load decline followed by spontaneous clearance, researchers performed this work to assess the predictors for the viral decline in a cohort of HCV-infected postpartum women. For viral decline and subsequent clearance, IL28B-CC genotype and 12-month postpartum undetectable viremia proved the best predictors. Researchers suggested considering these predictors while making a clinical decision.

Methods

• Researchers screened pregnant women at Cairo University for anti-HCV antibodies and HCV RNA, and tested viremic women for quantitative HCV RNA at 3, 6, 9, and 12 months postpartum.
• They defined spontaneous clearance as undetectable viremia twice at least 6-months apart.
• An assessment was performed of associations between viral load and demographic, obstetrical, HCV risk factors, and interleukin-28B gene (IL28B) polymorphism (rs12979860).

Results

• 2514 women were screened; 97 (3.9%) indicated anti-HCV antibodies, 54 (2.1%) were viremic and of those, 52 (2.1%) agreed to IL28B testing.
• From pregnancy until 12 months postpartum, a significant viral decline was observed in IL28B-CC allele women (P = .009).
• In this study, after adjusting, the IL28B-CC allele indicated a near significant difference compared to the CT allele (odds ratio [OR], 0.75; 95% confidence interval [CI], 0.75,1.00; P = .05), but not the TT allele (OR, 0.91; 95% CI, 0.61,1.38; P = .64).
• All 14/52 (26.9%) women who subsequently cleared were among the 15 with undetectable viremia at 12 months, this suggested time point a strong predictor of subsequent clearance (sensitivity = 100%, specificity = 97.4%, positive predictive value = 93.3%, negative predictive value = 100%).