New strategies are needed for identifying mothers with hepatitis C virus (HCV) antibodies and the neonates susceptible to maternal transmission of HCV, according to results of a study published in Obstetrics & Gynecology.

The number of reported cases of HCV has been rising annually, particularly among young women, leading to an increase in the number of neonates born to mothers who are HCV positive. In the United States, vertical transmission is the primary cause of HCV infection in children, with an overall 2%-8% rate of women living with HCV monoinfection. Universal screening for HCV in pregnancy has been suggested, but not adopted because, among other reasons, there are no currently recommended antiviral regimens for pregnant women, and thus treatment can only be initiated postpartum.

Researchers, therefore, sought to describe the prevalence of HCV antibody, evaluate current risk factors associated with HCV antibody positivity, and identify novel composite risk factors for identification of groups most likely to demonstrate HCV antibody seropositivity in an obstetric population from 2012 to 2015. Of 106,842 women who were screened for the HCV antibody, 254 had positive results, with an HCV antibody seroprevalence rate of 2.4 cases per 1000 women.

Factors associated with HCV antibody positivity included injection drug use, blood transfusion, having a partner with HCV, more than 3 lifetime sexual partners, and smoking. A composite of any of these potential risk factors provided the highest sensitivity for detecting HCV antibody (75 of 82 cases; 91%).


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A total of 129 women supplied samples for HCV RNA baseline testing; 68% were HCV RNA–positive (viremic) and 32% were HCV RNA–negative. Among the women who demonstrated a negative test, confirmatory testing with INNOLIA® indicated a false-positive rate of 3.1% with HCV antibody screening.

The study authors concluded that, “As we seek to appropriately include pregnant women in the efforts to reduce the prevalence of HCV, our analysis does not suggest universal screening to be an optimal strategy at this time.” They added, “We are called to continue to work collaboratively across such disciplines as obstetrics, pediatrics, infectious disease, gastroenterology, and addiction to appropriately include the unique populations of pregnant women and children into eradication efforts for HCV.”

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Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Prasad M, Saade GR, Sandoval G, et al. Hepatitis C virus antibody screening in a cohort of pregnant women identifying seroprevalence and risk factors. Obstet Gynecol. 2020;135:778–788.