Screening for hepatitis C virus infection in methadone‐maintained mothers and their infants

Abstract

Objective: To describe the patterns of screening for hepatitis C virus (HCV) infection in methadone‐maintained pregnant women and their infants. Design, setting and patients: Retrospective review of medical records from one rural and two metropolitan hospitals in New South Wales for pregnant women on methadone maintenance treatment and infants born to these women between 1 January 2000 and 31 December 2006, as well as records for pregnant women who were not on methadone treatment. Main outcome measures: Rates of anti‐HCV antibody and HCV RNA testing for pregnant women and their infants, and ages at which infants attended follow‐up appointments. Results: Of 295 pregnant women on methadone maintenance treatment, 288 were tested for anti‐HCV antibodies (98%), compared with 1995 of 9987 women who were not on methadone treatment (20%) (P < 0.001). Seropositive results were obtained for 243 women in the methadone group (84%) and 54 in the non‐methadone group (3%) (P < 0.001), of whom 44 (18%) and 17 (31%), respectively, were subsequently tested for HCV RNA (P = 0.03). HCV RNA test results were positive for 31 (70%) and 10 (59%) seropositive women in the methadone and non‐methadone groups, respectively (P = 0.39). Of infants of HCV‐seropositive methadone‐maintained mothers, 27% of those for whom we had follow‐up attendance data received HCV screening, and one of these infants tested positive for anti‐HCV antibodies and HCV RNA. Conclusions: Screening for HCV infection in the high‐risk population of pregnant women on methadone maintenance treatment and their infants is inadequate. This could lead to significant underdetection of active HCV infection in this high‐risk population, and their infants. Current screening guidelines may therefore need to be revised.

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

“…Until recently (2016), HCV infected pregnant in the Milagro Clinic did not get systematic referrals for HCV treatment during postpartum care unless they were abstinent, which may have also contributed to low genotype testing. Overall, the proportion tested, exposed, and infected with HCV in this cohort is similar to that seen in other studies of women with a history of opioid use disorder (Krans et al, 2016; Liu et al, 2009). A recent study of 791 pregnant women with a history of opioid use disorder in Pittsburgh found that a lower proportion were tested (77%) but showed similar anti-HCV prevalence (60.4%) and even lower rates of RNA and genotype testing (Krans et al, 2016).…”

“…Several studies have found higher than expected HCV infection rates among pregnant women not involved in pharmacotherapy programs, including in Australia, England and the U.S. (Kuncio et al, 2015; Liu et al, 2009; Orkin, Jeffery-Smith, Foster, & Tong, 2016). This finding led proposals to adopt universal prenatal HCV screening, as was done in Australia and New Zealand (Wilson & Beckmann, 2015).…”

“…A recent study of 791 pregnant women with a history of opioid use disorder in Pittsburgh found that a lower proportion were tested (77%) but showed similar anti-HCV prevalence (60.4%) and even lower rates of RNA and genotype testing (Krans et al, 2016). In 295 women attending methadone maintenance in Sydney, Australia, Liu et al, (Liu et al, 2009) found that 98% of pregnant women were tested for anti-HCV, of whom 84% were seropositive. However, only a fraction (18%) of women in that cohort were tested for RNA compared to almost all (96.8%) of women in our study.…”

A multicentre survey of hepatitis C awareness in a high‐risk population

“…There were a number of contradictory findings raised by this survey. While the majority of clients had been tested for HCV, the reported HCV prevalence rate of 48% is significantly lower than previously reported . Generally, HCV exposure rates in high‐risk populations are approximately 80% .…”

“…Vertical transmission of HCV occurs in 5–10% of HCV viraemic mothers . In a recent study, we have shown that although more than 70% of mothers on a methadone program are HCV positive, less than 20% of their children are tested for HCV at 18 months of age . This suggests striking non‐adherence to current best practice, a lack of awareness of HCV in this high‐risk population and that many children in this high‐risk population are lost to follow‐up and thus not identified .…”