Editing Hepatitis C (section)

== Special populations ==

=== Children and pregnancy ===
{{Main|HCV in children and pregnancy}}
Compared with adults, infection in children is much less understood. Worldwide the prevalence of {{nowrap|hepatitis C}} virus infection in pregnant women and children has been estimated to be 1–8% and 0.05–5% respectively.<ref name=Arshad2011>{{cite journal | vauthors = Arshad M, El-Kamary SS, Jhaveri R | title = Hepatitis C virus infection during pregnancy and the newborn period--are they opportunities for treatment? | journal = Journal of Viral Hepatitis | volume = 18 | issue = 4 | pages = 229–36 | date = April 2011 | pmid = 21392169 | doi = 10.1111/j.1365-2893.2010.01413.x | s2cid = 35515919 }}</ref> The [[Vertically transmitted infection|vertical transmission]] rate has been estimated to be 3–5% and there is a high rate of spontaneous clearance (25–50%) in the children. Higher rates have been reported for both vertical transmission (18%, 6–36%, and 41%)<ref name=Hunt1997>{{cite journal | vauthors = Hunt CM, Carson KL, Sharara AI | title = Hepatitis C in pregnancy | journal = Obstetrics and Gynecology | volume = 89 | issue = 5 Pt 2 | pages = 883–90 | date = May 1997 | pmid = 9166361 | doi = 10.1016/S0029-7844(97)81434-2 | s2cid = 23182340 }}</ref><ref name=Thomas1998>{{cite journal | vauthors = Thomas SL, Newell ML, Peckham CS, Ades AE, Hall AJ | title = A review of hepatitis C virus (HCV) vertical transmission: risks of transmission to infants born to mothers with and without HCV viraemia or human immunodeficiency virus infection | journal = International Journal of Epidemiology | volume = 27 | issue = 1 | pages = 108–17 | date = February 1998 | pmid = 9563703 | doi = 10.1093/ije/27.1.108 | doi-access =  }}</ref> and prevalence in children (15%).<ref name=Fischler2007>{{cite journal | vauthors = Fischler B | title = Hepatitis C virus infection | journal = Seminars in Fetal & Neonatal Medicine | volume = 12 | issue = 3 | pages = 168–73 | date = June 2007 | pmid = 17320495 | doi = 10.1016/j.siny.2007.01.008 | citeseerx = 10.1.1.852.7880 }}</ref>

In developed countries, transmission around the time of birth is now the leading cause of HCV infection. In the absence of the Hepatitis C virus in the mother's blood, transmission is rare.<ref name=Thomas1998 /> Factors associated with an increased rate of infection include membrane rupture of longer than 6 hours before delivery and procedures exposing the infant to maternal blood.<ref name=Indolfi2009>{{cite journal | vauthors = Indolfi G, Resti M | title = Perinatal transmission of hepatitis C virus infection | journal = Journal of Medical Virology | volume = 81 | issue = 5 | pages = 836–43 | date = May 2009 | pmid = 19319981 | doi = 10.1002/jmv.21437 | s2cid = 21207996 }}</ref> Cesarean sections are not recommended. Breastfeeding is considered safe if the nipples are not damaged. Infection around the time of birth in one child does not increase the risk in a subsequent pregnancy. All genotypes appear to have the same risk of transmission.

HCV infection is frequently found in children who have previously been presumed to have non-A, non-B hepatitis, and cryptogenic liver disease.<ref name="González-Peralta1997">{{cite journal | vauthors = González-Peralta RP | title = Hepatitis C virus infection in pediatric patients | journal = Clinics in Liver Disease | volume = 1 | issue = 3 | pages = 691–705, ix | date = November 1997 | pmid = 15560066 | doi = 10.1016/s1089-3261(05)70329-9 }}</ref> The presentation in childhood may be asymptomatic or with elevated liver function tests.<ref name=Suskind2004>{{cite journal | vauthors = Suskind DL, Rosenthal P | title = Chronic viral hepatitis | journal = Adolescent Medicine Clinics | volume = 15 | issue = 1 | pages = 145–58, x-xi | date = February 2004 | pmid = 15272262 | doi = 10.1016/j.admecli.2003.11.001 }}</ref> While the infection is commonly asymptomatic, both cirrhosis with liver failure and hepatocellular carcinoma may occur in childhood.

=== Immunosuppressed ===
{{See also|Hepatitis C and HIV coinfection}}
The rate of {{nowrap|hepatitis C}} in immunosuppressed people is higher. This is particularly true in those with [[human immunodeficiency virus]] infection, recipients of [[organ transplant]]s, and those with [[hypogammaglobulinemia]].<ref name=Einav2002>{{cite journal | vauthors = Einav S, Koziel MJ | title = Immunopathogenesis of hepatitis C virus in the immunosuppressed host | journal = Transplant Infectious Disease | volume = 4 | issue = 2 | pages = 85–92 | date = June 2002 | pmid = 12220245 | doi = 10.1034/j.1399-3062.2002.t01-2-02001.x | s2cid = 27843061 }}</ref> Infection in these people is associated with an unusually rapid progression to cirrhosis. People with stable HIV who never received medication for HCV may be treated with a combination of [[peginterferon]] plus [[ribavirin]] with caution to the possible side effects.<ref>{{cite journal | vauthors = Iorio A, Marchesini E, Awad T, Gluud LL | title = Antiviral treatment for chronic hepatitis C in patients with human immunodeficiency virus | journal = The Cochrane Database of Systematic Reviews | issue = 1 | pages = CD004888 | date = January 2010 | pmid = 20091566 | doi = 10.1002/14651858.CD004888.pub2 }}</ref>