Universal screening detects more HCV-positive cases in pregnancy

Universal screening for hepatitis C virus detected more infections in pregnant people, as well as transmission to infants, according to a presenter at the Conference on Retroviruses and Opportunistic Infections.

ACOG recently joined the CDC in its recommendation that all U.S. adults should be screened for HCV, including pregnant women. The U.S. Preventive Services Task Force recommends a similar approach.

“Until recently, there were two different screening recommendations for hepatitis C that differed in not only who to screen, but how to screen,” Catherine Anne Chappell, MD, MSc, assistant professor in the department of obstetrics, gynecology and reproductive sciences at University of Pittsburgh, said during her presentation.

Initially, Chappell’s hospital in western Pennsylvania employed risk-based screening, performing HCV immunoglobin G (IgG) tests in pregnant patients with certain risk factors. In June 2020, the hospital switched to universal HCV screening, which involved sending a reminder for screening if there was no HCV test ordered and a reminder for reflex HCV RNA testing if IgG was positive.

The researchers hypothesized that universal HCV screening would increase HCV detection among pregnant people, which would result in fewer undetected perinatal HCV transmissions.

Chappell and colleagues compared HCV detection in patients before and after universal screening was implemented. They examined the records of 12,142 patients who received prenatal care with risk-based HCV screening from Jan. 1 to Dec. 31, 2019, and those of 12,588 patients who received prenatal care with universal HCV screening from July 1, 2020, to June 30, 2021. Records from January to June 2020 were excluded to account for disruptions in health care due to COVID-19, the researchers said.

Universal HCV screening significantly increased the proportion of the population screened from 23% to 81% (P < .001). Among those who were tested, the rate of HCV IgG-positive results was higher among those with risk-based screening compared with universal screening (5.4% vs. 2.3%; P < .001); in the overall population, however, universal screening revealed a greater proportion of HCV IgG-positive patients than risk-based screening (1.9% vs. 1.2%; P < .001).

Reflex HCV testing increased the detection of active HCV in the obstetrical population from 0.091% with risk-based screening to 0.68% with universal screening (P < .001).

“Using the published rate of perinatal hepatitis C transmission [of 5.8%], and assuming that all exposed infants were tested, only one infant was identified using risk-based screening and five infants were identified using universal screening,” Chappell said. “Therefore, an additional four infants were identified with universal screening in just 1 year within our health care system.

“Pregnancy is a critical window of opportunity for engagement in the hepatitis C care cascade, and pregnant people must be included in the elimination strategy,” she said. “Universal screening is the first step, but we must have hepatitis C treatment in pregnancy so that we can have the ideal model of care, which is integrated care of test and treat during pregnancy.”