Diagnostic Gaps: Hepatitis C Screening Shortfalls Among Pregnant Women and Their Infants

According to the Centers for Disease Control and Prevention (CDC), incidence rates of hepatitis C (HCV) are increasing in adults who are of reproductive age. In fact, “rates of new HCV infections increased by more than 60% from 2015 to 2019. And in 2019, more than 63% of new HCV infections occurred among adults 20-39 years of age,” writes the federal agency on its site.

Additionally, CDC says it also expects perinatal HCV to increase as well. “Rates of HCV infection nearly doubled during 2009–2014 among people with live births. From 2011-2014, an estimated 29,000 HCV-infected patients gave birth each year. HCV can be transmitted from an infected mother to the child during both pregnancy and childbirth. HCV-infected mothers transmit their infection to their baby in 5.8% of pregnancies; the risk of transmission is higher if the mother is co-infected with HIV,” CDC says.

Of course, one of the ongoing challenges is HCV can often be asymptomatic, and it can lay dormant for years before causing health issues. However, those persons can still transmit the virus to others. Compounding the problem is that HCV screening remains traditionally low. A new study wanted to examine how the availability of maternal HCV viral load results during pregnancy was associated with pediatric HCV screening rates.

“Using an existing retrospective cohort of mother-infant pairs with longitudinal well-child care from a single healthcare system, we included infants born from 2015 to 2019 with perinatal HCV exposure based on maternal or infant HCV-specific ICD diagnosis codes and/or laboratory testing and confirmed by reviewing electronic health records,” the investigators wrote. “Maternal HCV VL during pregnancy was classified as positive (+), negative (-) or unknown based on HCV RNA testing (or lack-thereof) obtained between 12 months before to 3 months after the infant’s birth date. Adequate infant screening included an HCV RNA test obtained ≥ 2 months of age or an HCV antibody test ≥ 12 months of age.”

The results were reported at IDWeek.

“Of the 501 HCV-exposed infants, 139 (28%) were born to HCV+/VL- women, 100 (20%) to HCV+/VL unknown women, and 262 (52%) to HCV+/VL+ women. The proportion of screening tests ordered ranged from 68-82%, while test completion ranged from 64-70%,” the investigators wrote. “Overall, screening for HCV varied by maternal HCV VL (43% (60/139) HCV+/VL-; 50% (50/100) HCV+/VL unknown; 58% (152/262) HCV+/VL+).”

Testing shortfalls remained even in a patient population that should have triggered more screening.

“Although infants born to HCV+/VL+ women are more likely to be screened for HCV, many, regardless of maternal HCV VL during pregnancy, are never adequately screened and pediatric HCV infections are going undetected,” the investigators concluded.

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REFERENCE

DiNicola J, Chappell C, et al. Pediatric Hepatitis C Screening by Maternal Hepatitis C Viral Load Status in Pregnancy. Presented at: IDWeek 2023. October 11-14, 2023; Boston, MA. Abstract 1110.