Thank you for giving us the opportunity to respond to the letter from G. R. Foster et al. regarding our paper.
We agree that identification of HCV-infected individuals is important to enable initiation of treatment where appropriate to improve the outcome of chronic hepatitis C infection.
Although effective combination therapy to clear infection or reduce disease progression is now becoming available for adults, for women, initiation during pregnancy with the currently available drugs may be problematic and these therapies are not licensed for children. Indeed, the benefits of treating vertically infected children have not yet been evaluated. Interferon is not recommended in children less than 3 years old because of possible adverse effects on growth, and the natural history of vertically acquired infection (both clinical and virological) needs to be further clarified before treatment trials can start.
Antenatal screening for an infection is usually implemented to reduce mother-to-child transmission or to improve the outcome in infected infants. As there are currently no interventions of proven efficacy and safety to reduce mother-to-child transmission and a lack of knowledge about the natural history and treatment of vertically acquired infection, HCV infection does not currently fulfil the UK National Screening Committee guidelines for antenatal screening.
We thus agree that identification of HCV infection is important for anyone, but take issue with a focus on the antenatal period as the optimum time to do it. Contact with patients in other healthcare settings, such as in genitourinary clinics or postnatally, would provide more appropriate opportunities to test for HCV.