Preventing Perinatal Transmission of Hepatitis C

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Hepatitis C virus (HCV) infection is increasingin young adults, and better screening processes during pregnancy are warranted in order toprevent a subsequent increase in HCV infections in newborns. The authors used data from the “Recovery, Empowerment, Social Services, Prenatal care, Education, Community, and Treatment” (RESPECT) project from Boston Medical Center which cares for pregnant women with substance use disorders. Specifically, women with an opioid use disorder and who delivered a live birth from 2006 to 2015 were followed to see how well follow up occurred in a HCV cascade ofcare. The HCV cascade of care had managementcomponents utilized for both women and infants. Women who had live births were assessed for HCV infection. If they were HCV seropositive, they underwent HCV RNA testing to determine if they had viremia so that they could be linked to medical care. Subsequently, infants born to HCVseropositive mothers were screened per AmericanAcademy of Pediatrics guidelines, and all children with positive HCV antibody testing or RNA testing were linked to medical care, including consultationwith a pediatric infectious disease service. Motherswith and without HCV infection were compared, and multivariable logistic regression was used to determine various factors associated with linking to HCV care, including maternal age, race, distance from the medical center, HIV status, behavioral health diagnosis, tobacco use, substance use disorder, and opioid agonist therapy.

A total of 879 women with an associated opioid use disorder met inclusion criteria for the study and 510 subjects (68%) were HCV seropositive.Women who were seropositive were significantly more likely to be white, non-Hispanic, have a concomitant HIV infection, have used tobacco during pregnancy, and have been prescribed opioid agonist therapy at time of delivery. It was notedthat 369 of HCV seropositive women (72%) hadHCV RNA testing, but only 107 women who had positive HCV RNA testing (41%) were linked tosubsequent HCV care.

Additionally, 404 infants were included in the analysis who were born to mothers with positive HCV seropositivity. Only 180 infants (45%) finished testing for an HCV infection, and only5 of these infants (2.8%) were diagnosed withan HCV infection (and all of these infants were subsequently linked to care). Increased completion of HCV screening in infants was significantly associated with maternal HIV co-infection. Maternal methadone maintenance therapy also was associated with completion of HCV screening on univariate analysis only.

This study demonstrates that there are areasin the care chain warranting improvement forwomen and their infants with HCV positivity so that complete testing and potential referral for treatment can occur. This study shows that linking high-risk individuals to care has the opportunity to improve HCV treatment. It would be interesting to see how this care model would work in othergeographic regions of the United States.

Epstein R, Sabharwal V, Wachman E, Saia K, Vellozzi C, Hariri S, Linas B. Perinatal transmission of hepatitis C virus: defining the cascade of care. Journal of Pediatrics 2018; 203: 34-40