‘Significant gaps’ reported in testing, treatment among pregnant people with HCV
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Key takeaways:
- Of HCV antibody positive individuals, nearly 23% had their earliest RNA test during a pregnancy.
- Among nearly 5,000 individuals with a positive RNA test, less than 50% initiated treatment.
BOSTON — Researchers found “significant gaps” in follow-up testing and treatment among a cohort of pregnant individuals in Canada with a diagnosis of hepatitis C virus infection, according to data presented at The Liver Meeting.
“HCV infection among those of childbearing potential has increased,” Andrew B. Mendlowitz, PhD, MBiotech, a postdoctoral fellow at the Viral Hepatitis Care Network and Toronto Center for Liver Disease at University Health Network, told Healio.
Mendlowitz and colleagues conducted a population-based, retrospective cohort study of pregnancies in Ontario, Canada, that occurred between 2008 and 2020, which were then linked to HCV testing records from 1999 to 2020, as well as health administrative data.
Researchers used algorithms to identify pregnancy loss earlier than 20 weeks, induced abortion, prenatal ultrasound, livebirths and stillbirths, and also determined whether individuals tested positive for HCV antibody, were RNA tested, tested positive for HCV RNA and/or started treatment.
According to the abstract, pregnancies occurring after an individual tested positive for HCV antibodies but before subsequent RNA testing, and after a first positive HCV RNA test but before treatment defined study parameters for a missed opportunity for engagement.
“Despite diagnosis, there were major drop offs along the HCV cascade of care,” Mendlowitz said. “In particular, over half of the cohort did not receive RNA testing after a positive antibody result, and over half did not initiate treatment after confirmation of viremia.”
He continued, “Concerningly, in many people, subsequent pregnancies occurred after an HCV diagnosis with no evidence of treatment, posing a risk for transmission to the infants.”
Mendlowitz and colleagues identified 28,761 pregnancies among 13,432 individuals who were positive for HCV antibodies and/or had records of HCV RNA testing. Of these, 21.4% had their earliest HCV antibody test during a pregnancy.
Among individuals who ever tested positive for HCV antibodies, 86.9% received RNA testing, with 22.9% receiving their earliest RNA test during a pregnancy. Further, among 4,945 individuals with a record for HCV RNA-positive without spontaneous clearance, 41.6% initiated treatment.
Prior to 2012, the time to an RNA test from a positive antibody test was 47.5 weeks (95% CI, 41.7-53.7), which improved to 5.7 weeks (95% CI, 5.2-6.8) after 2018. Moreover, the time to treatment from an RNA-positive test improved from 15.1 years (95% CI, 14.1-16.2) to 1.9 years (95% CI, 1.6-2.2) during that time, according to the abstract.
Among individuals with a positive antibody test, 20.1% had at least one pregnancy before receiving a subsequent RNA test and a minority of those with an RNA-positive record received treatment. Of 4,936 individuals who were monitored from their first RNA-positive test, 45.9% had at least one pregnancy before initiating treatment.
The data also showed that 1,767 individuals were never linked to an RNA test, which corresponded to an average of 1.6 missed pregnancies per person. According to the abstract, an estimated 195 infants may have been infected as a consequence of missed opportunities for engagement.
“Importantly, our estimates were conservative and spoke to only the tip of the iceberg, as they do not account for the significant undiagnosed or not tested fraction,” Mendlowitz told Healio.
Researchers noted their analysis highlighted “significant gaps” in follow-up testing and treatment for HCV among pregnant individuals.
“We are hopeful that new guidelines recommending universal screening for HCV in each pregnancy and exploration of treatment in late pregnancy will improve HCV care for pregnant people and minimize the risk of transmission of HCV to newborns.”
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Mendlowitz AB, et al. Characterizing linkage to hepatitis C virus care during and following pregnancy: Identifying missed opportunities for testing and treatment. Presented at: The Liver Meeting; Nov. 10-14, 2023; Boston (hybrid meeting).
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