HCV Screening: A Missed Opportunity in Pregnancy?

A recent study has estimated the seroprevalence of hepatitis C virus (HCV) infection to be 0.5% in the antenatal population. It also suggested the need to change HCV screening strategies in light of improved HCV treatments that have emerged in recent decades.

Chloe Orkin, MD, Barts Health NHS Trust, London, United Kingdom, and colleagues used data from two busy hospitals to estimate the prevalence of HCV infection in pregnant women. The researchers published the results of their retrospective study in the British Medical Journal Open.

“We found the seroprevalence for anti-HCV to be 0.5% (0.1% viraemic) in our antenatal population, similar to the stated national prevalence of 0.4% and to the prevalence observed in previous antenatal studies performed in other areas of the [United Kingdom],” the authors write.

Hepatitis C remains a significant public health issue affecting an estimated 130 to 170 million people globally. If untreated, progression of this infectious disease in its chronic form can lead to significant morbidity—including cirrhosis, hepatocellular carcinoma, and liver failure—and mortality. However, recent advances in hepatitis C treatment have changed the clinical landscape. Direct-acting antiviral therapies for HCV now offer almost 100% cure rates, and are tolerable, of short duration, and accessible.

Nevertheless, approximately half of all individuals infected with HCV remain undiagnosed. Although universal screening for other blood-borne viruses, such as HIV, is recommended in the United States and the United Kingdom, this is not the case for HCV.

The US Centers for Disease Control and Prevention (CDC) currently recommends screening for hepatitis C only in individuals considered to be at high risk of infection—it does not recommend routine hepatitis C screening in pregnant women. Risk-based HCV testing is also conducted in the United Kingdom, as recommended by the National Institute for Health and Care Excellence (NICE). However, this strategy underestimates HCV prevalence because clinicians and patients interpret risk differently.

Although the incidence of HCV vertical transmission is 4% to 8%, studies to investigate whether antenatal HCV screening is justified were last conducted in the 1990s when treatment interventions were lacking.

Dr. Orkin and colleagues therefore conducted a retrospective study to determine the prevalence of active HCV infection in antenatal patients in two busy London hospitals, in order to assess the benefits of HCV screening in pregnant women.

They tested 1,000 samples from female patients aged 15 to 49 years and found that 5/1000 (0.5%; 95% confidence interval [CI], 0.06% to 0.94%) were reactive for anti-HCV and 1/1000 (0.1%; 95% CI, 0% to 0.3%) was HCV RNA positive.

However, according to the authors, “[o]wing to the methodology employed in sample acquisition, it is most likely that the results are an underestimation of the true size of the problem and this warrants further investigation with prospective anonymised sampling of the antenatal cohort.”

By extrapolating the results of this study, the authors estimate that, with over 700,000 antenatal clinic visits nationally, 700 viremic women could be identified annually, and even more viremic individuals could be identified by using contact screening. They say the costs of adding an HCV test as part of routine antenatal screening are minimal.

“The addition of anti-HCV testing to the well-established antenatal screening programme provides a unique opportunity to impact on the health of pregnant women, their children, partners and future pregnancies in this new era of treatment for hepatitis C,” the authors conclude.

Dr. Parry graduated from the University of Liverpool, England in 1997 and is a board-certified veterinary pathologist. After 13 years working in academia, she founded Midwest Veterinary Pathology, LLC where she now works as a private consultant. She is passionate about veterinary education and serves on the Indiana Veterinary Medical Association’s Continuing Education Committee. She regularly writes continuing education articles for veterinary organizations and journals, and has also served on the American College of Veterinary Pathologists’ Examination Committee and Education Committee.