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Rise of HCV among reproductive-age women suggests need for screening

A recent substantial increase in hepatitis C virus infection among reproduction-aged women in the United States highlights a need for routine HCV screening during pregnancy, according to recent data published in Annals Internal Medicine.

“The prevalence of HCV infection among pregnant women has been difficult to determine, because HCV screening is not performed routinely in this population but rather is risk based,” Kathleen N. Ly, MPH, from the Division of Viral Hepatitis at the CDC, and colleagues wrote. “As a result, many HCV infections may go undetected because of under-recognition of risk behaviors, as well as concerns about stigmatization or legal consequences if risk behaviors are disclosed.”

To determine the extent of the HCV infection among reproductive-aged women and their children in the United States, researchers analyzed National Notifiable Diseases Surveillance System (NNDSS) HCV case reports from 2006 to 2014 and Quest Diagnostics Health Trends data from 2011 to 2014. Study participants included 171,801 women aged 15 to 44 years and 1,859 children aged 2 and 13 years infected with HCV reported to the NNDSS, and 2.1 million reproductive-aged women and 56,684 children who had HCV testing by Quest Diagnostics.

The findings showed that the number of reproductive-aged women with acute and past/present HCV infection reported in the NNDSS doubled, from 15,550 in 2006 to 31,039 in 2014. The investigators found that out of 581,255 pregnant women tested by Quest from 2011 to 2014, 4,232 (0.73%; 95% CI, 0.71-0.75) were infected with HCV. During the same time period, 0.76% of children had HCV infection (95% CI, 0.69-0.83); however, the percentage among children aged 2 to 3 years was 3.2 times higher (1.62%; 95% CI, 1.34-1.96) compared with those aged 12 to 13 years (0.5% [95% CI, 0.41-0.62). When Ly and colleagues applied the Quest HCV infection rate to the annual live births from 2011 to 2014, they found an estimated average of 29,000 women (95% CI, 27,400-30,900) with HCV infection, who delivered 1,700 HCV-infected infants (95% CI, 1,200-2,200) each year.

“Although no HCV treatments have been approved by the [FDA] for use in pregnant women, clinical trials of promising drugs are under way,” Ly and colleagues wrote. “The data from this study may inform ongoing discussions of HCV screening for all pregnant women to protect their health and that of their offspring.”

In an accompanying editorial, Alfred DeMaria Jr., MD, from Massachusetts Department of Public Health, wrote that younger people with HCV infection face unique challenges because transmission of the virus is ongoing, the population is hard to reach, care is less accessible, and treatment services are limited. Often called a “silent epidemic,” it is critical to develop strategies that will effectively prevent or cure HCV infection in reproductive-aged women, he wrote.

“Much work lies ahead to eradicate HCV, starting with resources for public health surveillance to monitor incidence and prevalence, and to fully characterize the infection in the population... The public will be best protected from the consequences of HCV infection only if accurate surveillance data are available to guide prevention and care, innovative and effective treatment and medical care for substance use disorder are delivered to an often-marginalized population, and evidence-based harm reduction interventions are deployed,” DeMaria wrote. – by Savannah Demko

Disclosures: Ly reports no relevant financial disclosures. Please see the full study for a complete list of all other authors’ relevant disclosures. DeMaria reports no relevant financial disclosures.