Most babies born to HCV-positive women don't get tested for virus

Last Updated: 2016-02-08

By Anne Harding

NEW YORK (Reuters Health) - Most children born to women positive for hepatitis C virus (HCV) are not tested for HCV infection, according to new findings.

Less than one in five babies whose mothers were known to have chronic HCV had undergone adequate testing by 20 months of age, Danica Kuncio, of the Philadelphia Department of Public Health (PDPH), and her colleagues found. They reported their findings online January 20 in Clinical Infectious Diseases.

"Doctors should be aware that hepatitis C is definitely prevalent in women of childbearing age," Kuncio told Reuters Health. "The potential risk to their children should also be assessed by pediatricians or during childbirth or as part of prenatal care to ensure that both moms and infants are getting the best care for their potential infections as possible."

About 5% of children born to HCV-positive women will develop chronic HCV infection, Kuncio and her colleagues explain in their report. U.S. recommendations state that pregnant women with risk factors for HCV, such as injection drug use, should be tested for the virus.

However, Kuncio noted, pregnant women don't always disclose these risk factors to their doctors. For this reason, Australia has adopted universal screening of pregnant women for HCV, she added, and some individual practices in the U.S. are doing universal screening as well.

Identifying perinatal infection is crucial given the health risks of chronic HCV infection. "Children can develop early in life, even before age 10, cirrhosis or liver cancer, and require a liver transplant, all because of having an infection that is assaulting their liver," Kuncio said. "There can also be cognitive impairment or delays and other adverse health effects." And as the child grows up, she added, they may transmit HCV to others.

To investigate rates of HCV testing for children born to HCV-positive mothers in Philadelphia, the researchers looked at data from the PDPH's Hepatitis Registry. They identified 8,119 females 12 to 54 years old who were HCV-positive, 500 (5%) of whom had delivered at least one child in 2011-2013. These 537 children accounted for 1% of all children born in Philadelphia during the study period.

Eighty-four of these children, or 16%, had been tested for HCV. Four were confirmed to have the infection. Another 20 children would be expected to test positive for chronic HCV, based on the 5% transmission estimate, but had not been identified by the time they were 20 months old.

Direct acting antivirals (DAAs), which have revolutionized HCV treatment for adults, have not been approved for children, Kuncio noted, although pediatric clinical trials are now under way. "There's a lot of hope that these will be approved so that children can also have access to these drugs that are so much more tolerable than the old regimens," she said.

In the meantime, Kuncio said, facilities, regions, and states need to decide whether universal HCV screening of pregnant women is appropriate. "This paper shows that a conversation around perinatal hepatitis C really needs to come to the forefront at the national level," Kuncio said. "There are a lot of children that are potentially affected by this."

The authors reported no funding or disclosures.

SOURCE: http://bit.ly/1W7ZgE3

Clin Infect Dis 2016.