Why You Might Want to Screen More Patients for Hepatitis C

Andrew M. Kaunitz


August 11, 2016

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Hello. I'm Andrew Kaunitz, professor and associate chair of the Department of Obstetrics and Gynecology at the University of Florida College of Medicine. Today I'd like to discuss screening women of reproductive age for hepatitis C.

In late July, the Centers for Disease Control and Prevention (CDC) published in its Morbidity and Mortality Weekly Report that the prevalence of hepatitis C virus (HCV) is increasing among US women of reproductive age.[1] Chronic infections occur in at least three quarters of those infected with HCV, and several million men and women in the United States have chronic hepatitis, representing a leading cause of liver-related morbidity and mortality.[2]

Current and past injection-drug use represents the most common risk factor for HCV. Although effective treatment is now available, these medications are new, very expensive, and may not be accessible to those who are most in need. Furthermore, ongoing high-risk behavior can result in repeat infection.

The CDC report suggests that the increasing prevalence of injection-drug use among young adults likely explains the higher prevalence of HCV among women of reproductive age, and points out that the number of infants born to infected mothers is increasing dramatically. Vertical HCV transmission (ie, maternal infection that is passed to the infant) occurs in almost 6% of children born to women who are infected with only HCV. Transmission is substantially more likely with high HCV viral loads or concomitant HIV infection. Unfortunately, no intervention to prevent vertical HCV transmission is currently recommended.

HCV screening involves testing for antibodies, with viral detection tests used to confirm the presence of infection when antibody screens are positive. Clinicians should note that antibody testing is associated with a substantial false-positive rate. Currently, the American Congress of Obstetricians and Gynecologists recommends that pregnant women with risk factors be screened for HCV. However, the CDC suggests that clinicians also assess nonpregnant women of childbearing age for HCV risk factors and screen accordingly.

What are the health benefits of identifying HCV infection in nonpregnant women? Those who are found to harbor HCV can be encouraged to use highly effective contraceptives such as an IUD or implant, referred for rehabilitative treatment to eliminate high-risk behavior, and referred for treatment of HCV. Once the infection is eradicated, women could pursue pregnancy if they so choose. Accordingly, in order for screening nonpregnant women to be effective in preventing subsequent vertical HCV transmission, a number of hurdles will have to be cleared.

I would like to thank Dr Anna Wald, an infectious diseases expert at the University of Washington, for her valuable input in preparing these comments. Thank you for taking the time to view this video. I am Andrew Kaunitz.


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