Universal HCV Screening in Pregnancy Boosts Detection

If you want to find undiagnosed hepatitis C virus (HCV) infection in mothers-to-be, a universal testing program for the disease among all pregnant individuals is the way to go, a researcher reported.

Under a risk-based testing program in effect during 2019, doctors diagnosed 11 positive cases of HCV infection in pregnant people, but use of a universal testing approach that went into effect in mid-2020 detected 85 cases of HCV infection in the following 12 months (P<0.01), said Catherine Chappell, MD, of Magee-Women’s Research Institute and Foundation/University of Pittsburgh.

During the risk-based screening only about 23% of 12,142 pregnant people were screened for HCV, as compared with 81% of 12,588 in the universal screening period (P<0.001), according to the findings presented at the virtual Conference on Retroviruses and Opportunistic Infections.

Chappell said she and her colleagues initiated the study after the American College of Obstetrics and Gynecology joined the CDC and other agencies in recommending universal HCV screening of pregnant people.

“Universal hepatitis C virus screening is hypothesized to increase the detection of hepatitis C virus among pregnant people, resulting in fewer undetected perinatal hepatitis C virus transmissions,” Chappell said.

She noted that universal screening was implemented at her institution in June 2020 using a best practice alert in the electronic medical record, which provided a reminder if HCV testing was not ordered with the new obstetrics panel and reflex testing for HCV RNA if immunoglobulin G positive.

Given the HCV perinatal transmission rate of 5.8%, an additional four infants with perinatal HCV in 12 months would have been identified with universal screening that would have previously gone undetected with risk-based screening within the healthcare system, Chappell said.

“Risk-based HCV screening is insensitive for hepatitis C virus detection within the general obstetric population,” she said. “Universal hepatitis C virus screening resulted in a 7.5-fold increased detection rate of active hepatitis C virus detection in pregnant people.”

Chappell suggested that since pregnancy is a time of high healthcare engagement, these individuals should be part of an HCV-elimination program.

“Our findings strongly support universal HCV screening of pregnant people, not only to ensure that the pregnant person is linked to treatment, but also to ensure detection of all cases of perinatal hepatitis C virus transmission,” she said.

At a press conference that discussed the study, co-moderator Elaine Abrams, MD, of Columbia University Mailman School of Pubic Health in New York City, told MedPage Today that although she had not seen any related cost-effectiveness studies, she thought “it would be very feasible to add hepatitis C virus testing to the routine pregnancy panel.”

Also at the press conference, Chappell told MedPage Today that while a formal inquiry into risk factors for HCV was not conducted, anecdotally “several of the women who were detected with hepatitis C virus infection reported remote incidences of injected drug use that had not been previously reported.”

Study limitations, she noted, included that the research was performed at a single health system in Western Pennsylvania; that some individual providers could have used different screening practices during the two time periods, which might have contaminated the results; and that because the investigators were unable to link infant records in the current analysis, perinatal infant transmission had to be estimated, relying on a historical estimate on risk of mother-to-child transmission.