Hepatitis C Cascade of Care Among Pregnant Women on Opioid Agonist Pharmacotherapy Attending a Comprehensive Prenatal Program

Abstract

Background Given the large increases in opioid use among pregnant women and associations with hepatitis C virus (HCV) infection, screening pregnant women who are on (opioid agonist) pharmacotherapy for HCV infection has potential to inform medical care for these mothers as well as their newborns. We investigated the HCV testing cascade among pregnant women on pharmacotherapy in order to describe exposure and infection rates and to identify opportunities that would improve care. Methods Secondary analyses of laboratory results were performed for HCV testing, including anti-HCV, viremia (RNA) and genotype. Information was abstracted from the medical records of women who were followed at a comprehensive prenatal care clinic for women with substance use disorders at the University of New Mexico. Results The sample included 190 pregnant women, of whom 188 were on pharmacotherapy (43.7% on buprenorphine and 55.3% on methadone); the remaining two had tested positive for heroin or prescription opioids. A total of 178 (93.7%) were tested for anti-HCV, 94 (98.9%) of whom were tested for RNA, and 41 (57.7%) were genotyped. Prevalence of exposure to HCV by anti-HCV results was 53.3%, and 37.3% were positive for HCV RNA indicating chronic infection. Conclusions The high prevalence of exposure and infection with HCV in pregnant women who involved in pharmacotherapy for a substance use disorder indicate a need for ongoing surveillance and testing for HCV. Identifying HCV during pregnancy is crucial because this identification would serve to enhance medical care and potentially prevent vertical transmission. Identifying HCS would also facilitate referrals to newly available curative HCV treatments following delivery.

Perinatal Transmission of Hepatitis C Virus: Defining the Cascade of Care

“…RESPECT is a unique multidisciplinary prenatal care program, and the pediatric infectious diseases program at BMC has dedicated nursing staff regularly following missed visits with several attempts to reschedule, and this limits generalizability to other centers. However, our finding of low linkage to care for women is consistent with findings in comparable programs in New Mexico and Pittsburgh(16,17). We expect new diagnoses of HCV in community-based general obstetrics practices, without the referral infrastructure of RESPECT, will pose even greater challenges.…”

Hepatitis C Guidance 2019 Update: American Association for the Study of Liver Diseases–Infectious Diseases Society of America Recommendations for Testing, Managing, and Treating Hepatitis C Virus Infection

“…The rate of mother‐to‐child transmission of HCV infection is approximately 5%, although rates are higher among women with inadequately controlled HIV coinfection and in women with HCV RNA > 6 log 10 IU/mL . Universal prenatal hepatitis C screening, as recommended by the HCV guidance panel, is expected to facilitate improved identification of at‐risk infants who require HCV testing . This will likely result in better HCV disease case finding in the pediatric population.…”

“…(195)(196)(197)(198)(199)(200)(201) Universal prenatal hepatitis C screening, as recommended by the HCV guidance panel, is expected to facilitate improved identification of at-risk infants who require HCV testing. (202)(203)(204) This will likely result in better HCV disease case finding in the pediatric population.…”

Sexually acquired acute hepatitis C infection diagnosed during pregnancy: a case report of successful postpartum treatment

“…The increasing prevalence of HCV infection in pregnant women reflects the general rise of HCV infection in the United States due to opioid use. In a sample of pregnant women receiving pharmacotherapy for opioid addiction, more than half had been exposed to HCV and nearly 40% had chronic HCV [ 7 , 8 ]. The transmission of HCV is primarily parenteral, typically via shared needles during IV drug use.…”