New HCV testing guidelines aim to increase screening among exposed infants

BySara Kellner

Fact checked byCarol L. DiBerardino, MLA, ELS

Key takeaways:

Only 42% of exposed infants received appropriate testing for hepatitis C virus.
The CDC now recommends RNA testing for infants aged 2 to 6 months to prevent loss to follow-up.

From 2010 to 2020, less than half of perinatally exposed infants were tested for hepatitis C virus, according to a study, but experts are hopeful that new early testing guidelines will ensure more infants are screened and treated.

HCV infections quadrupled from 0.3 per 100,000 population in 2009 to 1.2 per 100,000 population in 2018, according to Ezzeldin Saleh, MD, FIDSA, FAAP, and Marcela Rodriguez, MD, pediatric infectious disease specialists from Southern Illinois University School of Medicine. Infection rates were especially high among people aged 20 to 29 years (3.1 per 100,000 population), Saleh and Rodriguez wrote in the Journal of the Pediatric Infectious Diseases Society.

The risk for transmission from pregnant women with HIV and HCV to infants was estimated to be around 7.2% to 12.1%, Saleh and Rodriguez wrote.

Ezzeldin Saleh, MD, FIDSA, FAAP

“Infants with perinatal hepatitis C are usually asymptomatic, so the diagnosis relies on identifying all mothers with hepatitis C infection during pregnancy,” Saleh told Healio.

In 2020, the CDC recommended HCV screening for every pregnancy, and testing exposed infants after age 18 months for HCV antibodies. However, less than half of exposed infants were tested, according to a retrospective study.

Gaps in testing

Rachel L. Epstein, MD, MScE, assistant professor of medicine in the section of infectious diseases at Boston University Chobanian and Avedisian School of Medicine, and colleagues conducted a retrospective national study of HCV testing among exposed infants born from 2010 through 2020. The researchers identified which test children received, if any, and whether the children received antiviral treatment. Median follow-up was 2.9 years (interquartile range, 1.5-4.8 years).

Among 8,516 infants exposed to HCV, less than half (45.8%) were tested for the virus, and 42.1% were appropriately tested, according to results published in the Journal of the Pediatric Infectious Diseases Society. Half of the children (51.3%) appropriately tested received antibody testing, 24.6% received RNA testing and 24.1% received both tests.

Of the children appropriately tested for HCV, 182 (5.1%) had positive RNA tests. There were 104 children eligible for treatment by age 3 years, but only 15 were treated.

The researchers uncovered racial and ethnic disparities in testing. Compared with white children, Black and Asian/Pacific Islander children were significantly less likely to receive appropriate testing (OR = 0.38; 95% CI, 0.26-0.55; and OR = 0.06; 95% CI, 0.03-0.11, respectively). Hispanic and Latinx children were less likely to receive appropriate testing than non-Hispanic children (OR = 0.56; 95% CI, 0.36-0.88).

“Unfortunately, communication between birthing parent and newborn clinicians and between hospitals and outpatient pediatricians is not always seamless,” Epstein told Healio. “Many diagnoses are likely not communicated clearly to pediatricians seeing the exposed children at 18 months of age, and many general pediatricians do not feel comfortable with HCV testing and diagnosis.”

New recommendations

In 2023, the CDC began recommending early testing among infants aged 2 to 6 months.

“The hope is that earlier and simple one-step testing will maximize the chances of testing all exposed children as they are seen for well-child visits around the same time,” Saleh told Healio. “Previous recommendations for testing after 18 months of age had led to a significant number of exposed children being lost to follow-up.”

The recommendations state that exposed children should receive an RNA test between age 2 and 6 months, or up to age 17 months if they have not been tested previously, Saleh and Rodriguez wrote. Children aged 18 months or older should receive an antibody test if they have no previous test history.

As Healio previously reported, a study found that up to 90% of exposed infants were tested in facilities where the policy was to screen at age 2 months.

Children with HCV infection are eligible for antiviral therapy after age 3 years, according to Saleh and Rodriguez. Saleh said antiviral treatment during pregnancy is currently being researched.

“General pediatricians are the first line in ensuring all infants exposed to hepatitis C virus are tested,” Epstein said. “Now that universal hepatitis C testing is recommended in pregnancy, pediatricians should ensure that maternal testing is checked and create a workflow to routinely test exposed infants with RNA testing at 2 to 6 months of age and make appropriate referrals for those testing positive.”