Universal hepatitis C screening in pregnancy improves case detection

Keith Alcorn
Published:
23 February 2022
Anastasiia Chepinska/Unsplash

Implementing universal testing for hepatitis C during pregnancy improved case detection 7.5-fold compared to the previous regime of risk-based screening, a research group from the University of Pittsburgh reported last week at the 2022 Conference on Retroviruses and Opportunistic Infections (CROI).

Hepatitis C prevalence among pregnant women in western Pennsylvania doubled between 2006 and 2016, from approximately 1% to over 2%. Increased prevalence of hepatitis C among pregnant women in Pennsylvania is a consequence of the opioid epidemic, said Dr Catherine Chappell of the University of Pittsburgh.

Screening for hepatitis C in pregnancy can enable early diagnosis before progression to cirrhosis and also prevent transmission of hepatitis C to the infant (the vertical transmission rate of hepatitis C is around 5%). Women receiving perinatal care are likely to be more motivated to test and remained engaged in care.

In the United States, recommendations for hepatitis C screening began to move from a risk-based screening approach to universal screening from 2018, when the American Association for the Study of Liver Diseases and the Infectious Diseases Society of America recommended screening of all pregnant women. Other bodies have subsequently reinforced this guidance, but it is not being implemented in all settings.

Reluctance to adopt universal screening is partly a consequence of a lack of evidence regarding prevention of vertical transmission, as well as the absence of clearly defined referral pathways in antenatal clinics for maternal hepatitis C treatment.

University of Pittsburgh Medical Center began to implement universal screening for hepatitis C during pregnancy in June 2020.

Dr Chappell presented a comparison of hepatitis C screening and case detection during periods of risk-based and universal screening in western Pennsylvania. The risk-based screening period chosen for analysis was 2019; the universal screening period ran from 1 July 2020 to 30 June 2021.

During the risk-based screening period, 12,142 women entered prenatal care. The study population was 19% Black, 72% White and 2% Hispanic. Just under half (46%) were covered by Medicare or Medicaid health insurance. During the universal screening period, 12,558 women entered care. Seventeen per cent were Black, 74% White and 2% Hispanic. Forty-five per cent had Medicare or Medicaid insurance.

Screening rates increased from 21% during risk-based screening to 81% during universal screening. The rate of confirmatory HCV RNA test also increased, from 22% to 95%, as a consequence of the use of reflex testing (automatically performing an HCV RNA test on any sample that has shown a positive HCV antibody result). During the risk-based screening period, eleven women were diagnosed with chronic hepatitis, a prevalence of 0.091%. During the universal screening period, 85 women were diagnosed with chronic hepatitis C, a prevalence of 0.68%.

It wasn’t possible to link to infant health records in this study, so the researchers estimated the number of infant hepatitis C cases based on a published transmission rate of 5.8%. They estimate that one infant with hepatitis C would have been identified as a result of risk-based screening of mothers, compared with five as a consequence of universal screening.

“Universal screening resulted in a 7.5-fold increase in the detection of chronic hepatitis C,” Dr Chappell concluded.

To establish a successful test-and-treat strategy for hepatitis C in pregnancy, universal screening during pregnancy needs to be accompanied by substance use treatment and hepatitis C treatment, she said.

Reference

Chappell C et al. Universal hepatitis C virus screening in pregnancy: the juice is worth the squeeze. Conference on Retroviruses and Opportunistic Infections, abstract 37, 2022.