Intrauterine Drug Exposure Linked With Increased Risk for Pediatric HCV

A recent study in Open Forum Infectious Diseases identified that intrauterine drug exposure (IUDE) is significantly associated with increased odds of hepatitis C virus (HCV) infection in the pediatric population that was examined.

The study, led by experts from the University of Cincinnati College of Medicine and the Cincinnati Children’s Hospital Medical Center, aimed to estimate the disease burden of HCV in a large Midwestern hospital and identify factors associated with HCV diagnostic testing among high-risk infants.

The retrospective analysis was conducted in a cohort of n=58,427 infants born from 2014-2016 in the Greater Cincinnati region. All newborns from the primary service area seen by a pediatrician between January 1, 2014, and December 31, 2016, were included in the study population. In the Greater Cincinnati area, universal maternal urine testing is conducted upon delivery to assess for IUDE. Although women have the option to opt out of testing, more than 98% give their consent.

The authors of the report noted that approximately 66.7% of maternally acquired HCV may be missed using current testing recommendations. They report that HCV prevalence among high-risk infants who were tested was 3.6%—5.2% of total births. Cases in infants who had been exposed to opioids had a more than 6-fold increase in odds of HCV infection (adjusted odds ration [aOR] 6.2 [95% confidence interval [CI] 2.3-16.6]) relative to non-opioid exposed infants. Prenatal care had no significant effect (aOR 1.2 [95%CI 0.4-3.5]) on the odds of a high-risk infant receiving HCV testing.

Based on positive maternal drug screening results or confirmed HIV or HBV infection, 5189 of infants (8.9%) were considered high-risk for HCV infection. Of the high-risk infants, 496 (9.6%) had documented HCV test results. Only 73.6% (365) of those with documented HCV test results were tested at the ages identified in CDC recommendations.

Nineteen (3.8%) of infants tested according to US Centers for Disease Control and Prevention (CDC) age recommendations were considered confirmed HCV-infected cases. An additional 17 (3.4%) were tested for HCV before the CDC age recommendation tested positive for HCV antibodies.

The investigators note that the latter group of infants are considered HCV-exposed cases, but testing to differentiate between infant infection and circulating maternal antibody was not completed before the completion of the study period. Of HCV-infected cases, 13 (68.4%) were confirmed current and 5 (31.6%) did not have testing to determine whether the infection was resolved or still current.

Study authors emphasized the need for increased focus on HCV identification in the pediatric population, given gaps in pediatric HCV testing identified in their work. Authors pointed out that the demographics of HCV have been impacted by the ongoing opioid crisis, which has increased HCV proliferation among millennials, highlighting a need to adapt testing to new realities.

Overall, HCV-associated mortality in the United States has declined nationally, but there are still gaps in treatment among at-risk subpopulations.

Study authors also noted that from 2003-2013, only 50% of adults with chronic HCV were aware of their status. This presents problems for identifying children at risk for maternal transmission.

In fact, investigators also pointed out that less than half of women in Ohio with medical records showing past or present HCV infection were tested during pregnancy. Investigators concluded that their findings “indicate that current testing recommendations may not properly address the barriers to HCV testing among high-risk infants, which likely contributes to the number of missed HCV infections.”