Hepatitis C Testing Among Perinatally Exposed Infants

Abstract

BACKGROUND: Hepatitis C virus (HCV) prevalence doubled among pregnant women from 2009 to 2014, reaching 3.4 per 1000 births nationwide. Infants exposed to HCV may acquire HCV by vertical transmission. National guidelines recommend that infants exposed to HCV be tested; however, it is unclear if these recommendations are being followed. Our objectives were to determine if infants exposed to HCV were tested and to determine hospital-and patient-level factors associated with differences in testing. METHODS: In this retrospective cohort study of infants exposed to HCV who were enrolled in the Tennessee Medicaid program, we used vital statistics-linked administrative data for infants born between January 1, 2005, and December 31, 2014. Infants were followed until 2 years old. Multilevel logistic regression was used to assess the association of HCV testing and hospital-and patient-level characteristics. RESULTS: Only 23% of 4072 infants exposed to HCV were tested. Infants whose mothers were white versus African American (96.6% vs 3.1%; P ,.001), used tobacco (78% vs 70%; P ,.001), and had HIV (1.3% vs 0.4%; P = .002) were more likely to be tested. Infants exposed to HCV who had a higher median of well-child visits (7 vs 6; P ,.001) were more likely to be tested. After accounting for maternal and infant characteristics and health care use patterns, African American infants were less likely to undergo general testing (adjusted odds ratio 0.32; 95% confidence interval, 0.13-0.78). CONCLUSIONS: Testing occurred in ,1 in 4 infants exposed to HCV and less frequently among African American infants. Public health systems need to be bolstered to ensure that infants exposed to HCV are tested for seroconversion. WHAT'S KNOWN ON THIS SUBJECT: Hepatitis C virus (HCV) prevalence is rising among pregnant women in the United States. Infants born to mothers with HCV should be tested because the virus can be acquired by vertical transmission. WHAT THIS STUDY ADDS: Less than 1 in 4 infants exposed to HCV were tested overall, with disparities in testing noted in African Americans and in those residing in a rural area. Efforts are needed to ensure that infants who are exposed to HCV are tested.

Neonatal Opioid Withdrawal Syndrome

“…Data suggest, however, that only a minority of exposed infants are tested. 97,98 Because infants with opioid exposure are at risk for HCV exposure, it is imperative that (1) all infants with opioid exposure are evaluated for HCV exposure and (2) all infants with HCV exposure are adequately managed to determine if they acquire the virus. All infants HCV exposure should be evaluated and should be tested for seroconversion by using RNA polymerase chain reaction or antibody testing.…”

Cascade of care for children and adolescents with chronic hepatitis C

“…They reported successfully screening for HCV among pregnant women with opioid use. In retrospective cohort study of infants exposed to HCV who were enrolled in the Tennessee Medicaid program, testing was conducted in only 23% of infants and less frequently among African American infants[ 16 ]. These two observations indicate that infant HCV screening is currently imperfect, emphasizing the need for programmatic changes to improve both mother and infant follow-up to bridge gaps in the cascade to cure.…”

Screening for Hepatitis C Virus: How Universal Is Universal?

“…These infants have always been included in the risk-based screening recommendations, but plenty of studies have shown that the ultimate screening rate for these infants is abysmal. 48 , 49 , 50 Screening at birth has not been shown to be effective, and antibody-based tests cannot be used until after 18 months due to passively transferred maternal antibody. The American Association for the Study of Liver Diseases and the Infectious Diseases Society of America (AASLD-IDSA) HCV Guidance Panel endorsed 2–6 months as an age window during which the use of an HCV RNA test seemed to offer reliable results to confirm or exclude infection.…”