A neonate born to an anti-HCV positive mother is tested for HCV infection at 18 months of age using anti-HCV ELISA — the test is positive. What is the correct interpretation and the recommended next step?
- A Confirmed HCV infection in the neonate; start direct-acting antiviral therapy immediately
- B Result likely reflects passively transferred maternal IgG antibodies; confirm with HCV RNA PCR or repeat anti-HCV at 18 months (if this is the 18-month result) ✓
- C Positive anti-HCV indicates immunity; no further testing needed
- D False-positive result; anti-HCV ELISA is unreliable in neonates and should not be used
Explanation
Maternal anti-HCV IgG crosses the placenta and can persist in the neonate for up to 18 months — a positive anti-HCV ELISA in a child <18 months of age cannot distinguish maternal antibody from true infant infection. The recommended approach is: test with HCV RNA PCR (which detects active viremia) at 2–6 months of age; if diagnosis is deferred, repeat anti-HCV ELISA after 18 months when maternal antibodies have cleared. A positive anti-HCV after 18 months suggests true infection, confirmed by HCV RNA. Direct-acting antivirals are approved for children ≥3 years (sofosbuvir/ledipasvir) or ≥3 years.
Reference: Ananthanarayan & Paniker's Textbook of Microbiology, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.