Perinatal HCV transmission needs national conversation

The results highlight the gap that exists in testing  infants born to HCV-positive women.

“As a result of missed opportunities, there are likely many children living with undiagnosed chronic HCV infection. An analysis of this type has not been done in the United States to date, shedding light on the need for a national conversation about perinatal HCV,” Danica Kuncio, MPH, viral hepatitis epidemiologist at the Philadelphia Department of Public Health in Philadelphia, recently told Medical Economics.

Kuncio and colleagues identified 8,119 females, 12 to 54 years old, who were HCV-positive, including 500 (5%) women who had delivered at least one child in 2011 to 2013. “We found that 1% of the births were to HCV-positive women and only 16% of their children had been tested for HCV, when all should have been screened,” said Kuncio.

Four instances of perinatal HCV were identified, and among the untested infants there were expected to be an additional 24 children with undiagnosed disease. These children are presumed to not be in care for their HCV infection, she said.

The researchers published their results online on January 20, 2016, in Clinical Infectious Diseases.

Perinatal transmission of HCV can result in chronic infection that may cause severe damage to the liver, ranging from fibrosis to hepatocellular carcinoma. “There may also be a risk of cognitive impacts from pediatric chronic HCV. There are no early symptoms associated with perinatal infection. Therefore, without testing for HCV in the first two years of life, many children are unable to be monitored for disease or treated for infection,” Kuncio said. “They may then transmit the disease to others unknowingly, and infection may only be diagnosed when the damage to the liver is extensive.”

Revolutionary direct acting antivirals have not been approved for children, she noted, although pediatric clinical trials are currently in progress.

A clinical practice that predominantly sees a population of women who are at high risk of being HCV-positive may want to consider universal screening. Risk factors include a history of injection drug use, sex with an infected person and tattoos from unlicensed facilities.

“Women do not always share incriminating risk behaviors with their provider, especially if the risk is unrecognized by the patient or occurred in the remote past. By providing universal HCV screening, the provider’s knowledge is not limited by patient acknowledgment of risk,” Kuncio said, noting that the American College of Obstetrics and Gynecology does not recommend universal screening.

She suggested that women of child-bearing age who are HCV-positive be made aware of the risk for perinatal transmission, even if they are not pregnant at the time.

“These women should be counseled to report their HCV status to their prenatal care providers and obstetricians should they become pregnant in the future. Women should also be referred to an HCV specialist for evaluation and treatment, which may cure disease and prevent the transmission of HCV perinatally or through other routes,” Kuncio said.