Hepatitis C Seroprevalence Among HIV-Infected Childbearing Women in New York State in 2006

Abstract

Objective To identify factors associated with maternal hepatitis C virus (HCV) seroprevalence and transmission of HCV as identified by qualitative HCV ribonucleic acid (RNA) in the infants of human immunodeficiency virus (HIV) infected women delivering in New York State (NYS) in 2006. Study Design In this retrospective cohort study of HIV-exposed infants born in NYS, leftover infant plasma from HIV diagnostic testing was deidentified and tested for HCV. If HCV antibodies were detected, a second specimen collected when the infant was [2 months old was tested for HCV qualitative RNA. Multivariate logistic regression was used to identify factors associated with HCV seropositivity. Results In a final sample of 553 live birth events with perinatal HIV exposure, 21 (3.8 %) of tested infant specimens had HCV antibodies indicative of maternal HCV seropositivity.Maternal age at delivery of [35 years, Hispanic ethnicity, white race and injection drug use (IDU) were significantly associated with HCV seropositivity in multivariate analysis. No cases of HCV vertical transmission were identified among HCV exposed infant specimens. Conclusions This statewide population-based study of HIV-infected childbearing women shows HCV seroprevalence of 3.8 %. Maternal age of [35 years and IDU are the strongest predictors of HCV seropositivity. Although no viral transmission was documented, more comprehensive longitudinal testing would be required to conclude that HCV transmission did not occur. SignificanceThis statewide population-based study of HIV-infected childbearing women shows HCV seroprevalence of 3.8 %.The study results help in better understanding of the overall epidemiology of HCV and reinforce the current HCV screening recommendations among pregnant women infected with HIV. The identified seroprevalence of HCV may raise awareness among health care providers and ensure appropriate HCV screening and early identification of HCV among HIV infected women of childbearing age (15-45 years old).

Pragmatic Experience with Risk-based versus Universal Hepatitis C Screening in Pregnancy: Detection of Infection and Postpartum Linkage to Care

“…1,32 This significant disease burden in pregnancy is driven by substance use behaviors seen in our center and those with even higher rates of women reporting intravenous (IV) drug use (i.e., Ohio, New York State, Tennessee). 7,8,10 Our understanding of HCV treatment uptake rates following pregnancy is poorly understood, and seems to be poor in multiple U.S. settings, assumed to be $25% at best. 1,25,33 In a real-world experience in London (where universal access to care is available), during the interferon era, HCV treatment uptake was 24% (19 of 78 viremic postpartum patients) and 14 patients (74%) achieved cure.…”

“…6 Currently, 0.75 to 2.5% of pregnant women in the United States are seropositive for HCV, with rates in pregnancy as high as 4 to 8% in some regions worldwide and 30 to 60% in women with active opioid use disorder. 3,[6][7][8][9][10][11][12] The vertical HCV transmission rate in pregnant women with active infection (HCV viremia) is 5 to 6%. [13][14][15] Currently, there is no approved maternal treatment of HCV in pregnancy and no available mechanism to decrease HCV transmission risk from mother to infant while in utero or during delivery.…”

Evidence for Implementation: HIV/HCV Coinfection and Pregnancy

“…Nationally representative data about prevalence of HCV among pregnant people with HIV the USA are lacking. In 2006, an estimated 3.8% of women with HIV presenting for delivery in New York State were coinfected with HIV and HCV [ 23 ]. European studies estimate the prevalence of HIV/HCV coinfection among pregnant people with HIV to be between 2 and 12% [ 15 ].…”