HCV Screening Rates Very Low Among Exposed Infants

The number of pregnant women infected with hepatitis C virus (HCV) is growing rapidly due to the opioid epidemic, yet most prenatally infected children are not being screened, despite the risk that approximately 6 percent will become infected, according to a study published May 2 in Pediatrics. Less than one-third of HCV-exposed infants receiving well-child care are being tested for HCV.

"Without appropriate screening, children who are at risk for perinatal transmission may remain undiagnosed until they become symptomatic or have abnormal liver enzyme levels found incidentally," write the authors led by Catherine Chappell, M.D., from University of Pittsburgh in Pennsylvania. "Delays in diagnosis could lead to delays in appropriate referrals and curative treatment or irreversible liver disease, such as cirrhosis or hepatocellular carcinoma."

According to recommendations from the Infectious Diseases Society of America, all infants born to HCV-infected women should be screened for HCV with an HCV antibody test at or after 18 months of age.‍ (Before age 18 months, HCV RNA can be detected by a polymerase chain reaction (PCR), but this is not the screening test of choice for perinatal HCV transmission and chronic pediatric HCV infection.)

Researchers retrospectively identified a cohort of pregnant, HCV-infected women who delivered at the University of Pittsburgh Medical Center health system between 2006 and 2014 through billing codes. Infant records linked to the HCV-infected pregnant women were assessed for the receipt of well-child services in the same health care system, defined as the presence of hemoglobin and/or lead testing at or after nine months of age. The status of HCV screening was assessed in this cohort.

The researchers found that 1,043 HCV-infected pregnant women delivered over the study period (1.2 percent of all deliveries). The prevalence of HCV increased by 60 percent over the nine years. Roughly one-third of infants (n=323) received well-child services in the health care system, but less than one-third of these exposed infants (30 percent) were screened for HCV. Infants whose mothers had a diagnosis of opioid use disorder were more likely to receive HCV screening.

Of the 96 screened infants, three-quarters were screened with HCV antibody tests, while one-quarter were screened with HCV PCR tests, and 3 percent were screened with both tests simultaneously. Suboptimal HCV screening was performed in 23 children either because HCV antibody tests were sent before 18 months of age (48 percent) or because HCV PCR tests were sent after 18 months of age (52 percent).

The authors say that one reason for low screening of infants is that maternal HCV status may not transfer to pediatric records. Furthermore, the authors suspect that the prevalence of HCV-infected pregnant women and exposed infants could be underreported, since HCV is not universally tested for during pregnancy.

"Given the difficulties involved with risk-based screening and the increasing prevalence of HCV among pregnant women, consideration should be given to the evaluation and implementation of universal HCV screening during pregnancy, especially in high-prevalence areas," write Chappell and colleagues.

Takeaway: HCV screening of prenatally exposed infants during well-child care is extremely low. Given the increasing prevalence of HCV in reproductive-aged women as a result of the opioid epidemic, strategies are needed to increase screening during pregnancy in exposed infants.