Source:

Epstein
RL
,
Sabharwal
V
,
Wachman
EM
, et al
.
Perinatal transmission of hepatitis C virus: defining the cascade of care
.
J Pediatr.
2018
;
203
:
34.e1
40.e1
; doi:
https://doi.org/10.1016/j.jpeds.2018.07.006

Investigators from the Boston Medical Center (BMC) and the CDC conducted a study to assess rates of testing for hepatitis C virus (HCV) among pregnant women with a history of opioid use and their children. Study participants were women who were enrolled in the Recovery, Empowerment, Social Services, Perinatal care, Education and Community and Treatment (RESPECT) program at BMC who had a diagnosis of opioid use disorder and delivered a live baby between 2006 and 2015. Data from the RESPECT program registry, including demographic characteristics, medical history, and birth outcomes, were abstracted for the study. In addition, the medical records of participants and their offspring were reviewed to determine HCV-related laboratory test results, such as HCV antibody (anti-HCV) testing, nucleic acid testing (ribonucleic acid [RNA]), and HIV testing.

The rate of any testing for HCV among mothers in the study was assessed, and for those tested, the rate of HCV (defined as a positive anti-HCV test result) was calculated. For women with HCV, the rate of RNA testing was determined, and for those with RNA test results, the rate of chronic HCV (defined as a positive RNA test result during pregnancy) was calculated. Rates of any testing and complete testing for HCV in children born to mothers who were anti-HCV positive were assessed. Complete testing was defined as test results sufficient to diagnose HCV (2 positive HCV RNA test results or being anti-HCV positive at ≥18 months of age) or to exclude the diagnosis (2 negative HCV RNA test results at least 1 month apart or anti-HCV negative test results at any age). Multivariate regression was used to identify variables associated with vertical transmission of HCV.

Data were analyzed in 879 women; 744 (85%) were tested for HCV. Of those tested, 510 (68%) were anti-HCV positive. Among women who were anti-HCV positive, 369 (72%) had RNA test results documented during pregnancy; of these, 261 (71%) had HCV RNA detected, corresponding to an estimate of chronic HCV of at least 30% (261 of 879) in study participants. There were 404 infants born to mothers who were anti-HCV positive who were ≥18 months old at the time of the analysis; of these, 273 (68%) had evidence of at least one HCV test, and 180 (45%) had undergone complete testing. Five of the 180 infants with complete testing had HCV infection. Among characteristics assessed, only maternal HIV was independently associated with vertical transmission of HCV in multivariate analyses (OR, 9.0; 95% CI, 1.1–72.8).

The authors conclude that HCV is common in women with opioid use, and screening in infants born to mothers with HCV is incomplete.

Dr Doolittle has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

HCV infection...

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