Few Perinatally Exposed Infants Receive Recommended Hep C Testing

By Will Boggs MD

February 18, 2020

NEW YORK (Reuters Health) - Fewer than a quarter of infants exposed perinatally to hepatitis C virus (HCV) undergo testing for the virus, according to a database study.

"Hepatitis C virus infections are increasing in the United States as a likely complication of the opioid crisis," Dr. Stephen W. Patrick of Vanderbilt University Medical Center, in Nashville, told Reuters Health by email. "Our findings suggest that there is a need to improve public health systems that ensure infants exposed to hepatitis C are tested for seroconversion. For infants who are not appropriately tested and followed, there is a risk they will acquire the virus leading to liver failure."

National guidelines say infants exposed to HCV should be tested with an HCV antibody at 18 months of age or with an HCV RNA PCR starting at 1 to 2 months. Published studies indicate that testing rates actually range from 16% to 68%.

Dr. Patrick's team used linked databases to investigate HCV testing rates among more than 4,000 infants exposed to HCV who were enrolled in the Tennessee Medicaid program from 2005 through 2014 and followed until they were 2 years old.

The prevalence of infants exposed to HCV increased each year, from 5.1 per 1,000 live births in 2005 to 22.7 per 1,000 live births in 2014 (P<0.001), with rates rising most sharply for white mothers.

Overall, 23% of infants exposed to HCV underwent any HCV testing in the first 24 months of life, and only 18% satisfied the definition for adequate testing, the researchers report in Pediatrics.

Factors associated with adequate HCV testing included white race, urban residents, maternal tobacco use, maternal HIV co-infection, lower birth weight, small for gestational age, NICU admission, and more well-child checks.

After accounting for other factors, African American infants exposed to HCV had 68% lower odds of undergoing HCV testing than white infants, a significant difference.

"Unfortunately," the authors note, "there are currently no recommended medical interventions to lower the risk of vertical transmission during pregnancy. Of infants who acquire HCV, 20% will have an acute resolving infection, 50% will develop a chronic asymptomatic infection, and 30% will develop a chronic active infection."

"Physicians should be aware that hepatitis C infections among pregnant women are rising and exposed infants are seldom tested for seroconversion," Dr. Patrick said. "Primary-care physicians caring for infants should be aware that hepatitis C-exposed infants should be tested within the first two years of life."

"In addition," he said, "because testing for hepatitis C virus in pregnancy is not universal, providers caring for infants should be aware of risk factors that are associated of hepatitis C infection, including opioid exposure."

Dr. Rachel L. Epstein of Boston Medical Center, who recently reported a high prevalence of HCV infection among pregnant women with opioid use and low rates of HCV testing of their infants, told Reuters Health by email, "Strategies are needed to improve follow-up for infants exposed to maternal HCV and to reduce the overall burden of HCV in women of reproductive age."

"The findings support a reconsideration of our strategy for infant HCV testing and whether RNA testing (for HCV viremia) in the first year of life would improve identification of potentially HCV-infected infants and obviate what appears to be significant loss to follow-up," she said.

"Identifying HCV-infected infants offers the opportunity for early cure now that direct-acting antivirals have been approved for use as early as age 3 years," said Dr. Epstein, who was not involved in the study. "Clinicians seeing children (either a newborn or a child transferring into a practice) born to a mother with known HCV or current or historical use of opioid or other injectable substances should review maternal records for HCV testing and documentation of the infant's HCV status or perform follow-up testing as appropriate."

Dr. John W. Ward, director of the Task Force for Global Health's Coalition for Global Hepatitis Elimination, in Decatur, Georgia, told Reuters Health by email, "We clinicians must recognize hepatitis C infection is a growing risk for maternal and child health in the United States and follow recommendations for HCV screening of young adults and children at risk. Working together - public health, clinicians, and communities - we can eliminate this health risk for mothers and babies."

"Antiviral therapy as a key intervention to prevent perinatal HIV and hepatitis B," said Dr. Ward, who also did not take part in the new research. "Studies are underway to assess the safety and effectiveness of treating and curing pregnant women and preventing perinatal transmission (of HCV)."

The study had no commercial funding. One of Dr. Patrick's coauthors reports ties to Gilead Sciences, which makes hepatitis C medications.

SOURCE: https://bit.ly/38x6y1a Pediatrics, online February 14, 2020.