Hepatitis C Virus universal screening versus risk based selective screening during pregnancy

Abstract

OBJECTIVES:

We sought to compare the value of HCV universal screening versus risk-based selective screening in pregnant women.

STUDY DESIGN:

In a prospective observational study (Jan 2012 - March 2012), pregnant women, in a high risk inner city clinic, who were at “low risk” for HCV infection were tested for HCV antibodies (universal screening) and their medical records were compared to the medical records of pregnant women who were at “high risk” (risk based selective screening as assessed by their obstetricians’ screening questionnaire).

RESULTS:

During the study period, 419 women delivered at our institution with 8.8% (37/419) at high risk for HCV. In 95% (183/193) of available and consenting low risk women, HCV antibody testing was done. The prevalence of HCV was 3.18% (7/220; 95% CI: 1.36–6.50) in all tested women versus 0.95% (4/419; 95% CI: 0.31–2.59) in risk-based selectively tested women. Overall the screening questionnaire had a sensitivity of 0.85 (0.42–0.99) and a specificity of 0.52 (0.45–0.58) in all women who had HCV antibody testing and questionnaire screening.

CONCLUSIONS:

Using a screening questionnaire to identify women at risk for HCV infection during pregnancy under-estimates the real prevalence of HCV. A universal screening should be considered in high risk cities.

Keywords

Hepatitis C Virus universal screening risk-based screening pregnancy

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References

Bréchot

. Hepatitis C virus. Dig Dis Sci 1996;41:6S–21S.

Chen

, Morgan

. The natural history of Hepatitis C virus (HCV) infection. Int J Med Sci 2006;3(2):47–52.

Thomas

, Astemborski

, Rai

, Anania

, Schaeffer

, Galai

, et al. The natural history of Hepatitis C virus infection: Host, viral, and environmental factors. JAMA 2000;284:450–456.

Armstrong

, Wasley

, Simard

, McQuillan

, Kuhnert

, Alter

. The prevalence of hepatitis C virus infection in the United States, through Ann Intern Med 2006;144:705–714.

Ohto

, Terazawa

, Sasaki

, Hino

, Ishiwata

. Transmission of Hepatitis C virus from mothers to infants. The Vertical Transmission of Hepatitis C Virus Collaborative Study Grou. N Engl J Med 1994;330:744–750.

Resti

, Azzari

, Mannelli

, Moriondo

, Novembre

, de Martino

. Mother to child transmission of Hepatitis C virus: Prospective study of risk factors and timing of infection in children born to women seronegative for HIV-1. Tuscany Study Group on Hepatitis C Virus Infection. BMJ 1998;317:437–441.

Conte

, Fraquelli

, Prati

, Colucci

, Minola

. Prevalence and clinical course of chronic Hepatitis C virus (HCV) infection and rate of HCV vertical transmission in a cohort of 15,250 pregnant women. Hepatology 2000;31:751–755.

Jhaveri

. Diagnosis and management of hepatitis C virus-infected children. Pediatr Infect Dis J 2011;30:983–5.

Pergam

, Hawes

, Gardella

, Wang

. HCV and pregnancy: Is now the time for universal testing? Future Virol 2008;3(1):1–5.

10.

Guidelines for perinatal care. American Academy of Pediatrics, American College of Obstetricians and Gynecologists 6th ed. Elk Grove Village, IL: 2007:303–48.

11.

National Collaborating Centre for Women’s and Children’s Health. Antenatal care: Routine care for the healthy pregnant woman. http://www.rcog.org.uk/resources/Public/Antenatal_Care.pdf. Accessed January 17, 2012.

12.

American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 86: Viral hepatitis in pregnancy. Obstet Gynecol 2007;110:941–956.

13.

Burns

, Minkoff

. Hepatitis C: Screening in pregnancy. Obstet Gynecol 1999;94:1044–1048.

14.

Center for Disease Control and Prevention. Recommendations for Prevention and Control of Hepatitis C Virus (HCV) Infection andHCV-Related Chronic Disease.MMWR Recomm Rep 1998;47:1–39.

15.

Center for Disease Control and Prevention. Hepatitis C Virus Infection Among Adolescents and Young Adults: Massachusetts, 2002–2009. MMWR Morb Mortal Wkly Rep 2011;60:537–41.

16.

Wise

, Bialek

, Finelli

, Bell

, Sorvillo

. Changing trends in hepatitis C–related mortality in the United States1995–2004. Hepatology 2008;47:1128–1135.

17.

European Paediatric Hepatitis C Virus Network. Three broad modalities in the natural history of vertically acquired hepatitis C virus infection. Clin Infect Dis 2005;41:45–51.

18.

American Academy of Pediatrics Committee on Pediatric AIDS. HIV testing and prophylaxis to prevent mother-tochild transmission in the United States. Pediatrics 2008;122:1127–1234.

19.

U.S. Preventive Services Task Force. Screening for hepatitis B virus infection in pregnancy: U.S. Preventive Services Task Force reaffirmation recommendation statement. Ann Intern Med 2009;150:869–73.

20.

Sulkowski

, Gardiner

, Rodriguez-Torres

, Reddy

, Hassanein

, Jacobson

. Daclatasvir plus sofosbuvir for previously treated or untreated chronic HCV infection. N Engl J Med 2014;370:211–121.

21.

McDermott

, Moravac

, Yudin

. The effectiveness of screening for hepatitis C in pregnancy. J Obstet Gynaecol Can 2010;32:1035–1041.

22.

Coffin

, Stevens

, Scott

, Stekler

, Golden

. Patient acceptance of universal screening for hepatitis C virus infection. BMC Infect Dis 2011;11:160.

23.

Ward

, Tudor-Williams

, Cotziasa

, Hargreaves

, Regana

, Foster

. Prevalence of hepatitis C among pregnant women attending an inner London obstetric department: Uptake and acceptability of named antenatal testing. Gut 2000;47:277–280.

24.

Scheinmann

, Hagan

, Lelutiu-Weinberger

, et al. Non-Injection Drug Use and Hepatitis C Virus: A Systematic Review. Drug Alcohol Depend 2007;89:1–12.

25.

Judd

, Hickman

, Rhodes

. Transmission of hepatitis C–are non-injecting cocaine users at risk? Subst Use Misuse 2002;37:573–575.

26.

Gyarmathy

, Neaigus

, Miller

, Friedman

, Des

Jarlais DC

. Risk correlates of prevalent HIV, Hepatitis B virus, and Hepatitis C virus infections among non-injecting heroin users. J Acquir Immune Defic Syndr 2002;30:448–456.

27.

Howe

, Fuller

, Ompad

, et al. Association of sex, hygiene and drug equipment sharing with Hepatitis C virus infection among non-injecting drug users in New York City. Drug Alcohol Depend 2005;79:389–395.

28.

McMahon

, Tortu

. A potential hidden source of hepatitis C infection among non-injecting drug users. J Psychoactive Drugs 2003;35:455–460.

29.

Centers for Disease Control and Prevention. Recommendations for prevention and control of hepatitis C virus (HCV) infection and HCV-related chronic disease. Centers for Disease Control and Prevention. MMWR Recomm Rep 1998;47:1–39.

30.

Wasley

, Miller

, Finelli

. Centers for Disease Control and Prevention. Surveillance for acute viral hepatitis–United States, 2005.. MMWR Surveill Summ 2007;6:1–24.

31.

Terrault

. Sexual activity as a risk factor for Hepatitis C. Hepatology 2002;36:S199–S105.

32.

Boaz

, Fiore

, Schrag

, Gonik

, Schulkin

. screening and counseling practices reported by obstetrician–gynecologists for patients with hepatitis c virus infection. Infect Dis Obstet Gynecol 2003;11:39–44.

33.

Chak

, Talal

, Sherman

, Schiff

, Saab

. Hepatitis C virus infection in USA: An estimate of true prevalence. Liver Int 2011;31:1090–1101.

34.

Basseri

, Yamini

, Chee

, Enayati

, Tran

, Poordad

. Comorbidities associated with the increasing burden of hepatitis C infection. Liver Int 2010;30:1012–1018.

35.

Cohen

, Bloom

. Access to and utilization of medical care for young adults aged 20–29 years: United States, 2008. NCHS data brief, no 29. Hyattsville, MD: National Center for Health Statistics. CDC 2010. Available at: http://www.cdc.gov/nchs/data/databriefs/db29.htm. Accessed February 24th, 2014.

36.

Kirzinger

, Cohen

, Gindi

. Health Care Access and Utilization Among Young Adults Aged 19–25: Early Release of Estimates From the National Health Interview Survey, January–September 2011. Division of Health Interview Statistics, National Center for Health Statistics. CDC 2012. Available at: http://www.cdc.gov/nchs/data/nhis/earlyrelease/Young_Adults_Health_Access_12.pdf Accessed February 24th, 2014.

37.

Arshad

, El-Kamary

, Jhaveri

. Hepatitis C virus infection during pregnancy and the newborn period–are they opportunities for treatment? J Viral Hepat 2011;18:229–236.

38.

Prasad

, Honegger

. Hepatitis C virus in pregnancy. Am J Perinatol 2013;30:149–159.