CDC Recommends HCV Testing for Perinatally Exposed Infants The U.S. Centers for Disease Control and Prevention (CDC) issues new recommendations1 Test all perinatally exposed infants and children for hepatitis C virus (HCV) and refer patients who test positive to appropriate care and treatments approved for use in children 3 years of age.
“Proper identification, referral to care, and curative treatment of perinatally infected children are critical to achieving the goal of eliminating hepatitis C,” declared Lakshmi Panagiotakopoulos, MD, Section of Viral Hepatitis, National Center for HIV, Viral Hepatitis, and Sexually Transmitted Diseases (STD) and tuberculosis (TB) prevention, Centers for Disease Control and Prevention, Atlanta, GA, and colleagues.
Four new recommendations have been issued to address the more than threefold increase in the incidence of hepatitis C virus in people of childbearing age between 2010 and 2021 and the 6% to 7% of infants and children who were perinatally exposed to hepatitis C virus.
These recommendations complement the 2020 recommendations for hepatitis C screening in adults, which include universal screening of pregnant women during every pregnancy, and update recommendations from 1998 on the type and timing of designated testing as technology evolves guide.
4 main recommendations:
- Test all perinatally exposed infants for HCV with nucleic acid testing (NAT) to detect HCV RNA between 2 and 6 months of age
- Consult a health care provider with expertise in pediatric hepatitis C management for all infants and children with detectable HCV RNA
- Perinatally exposed infants and children with undetectable HCV RNA results after 2 months of age do not require further follow-up unless clinically warranted.
- HCV RNA NAT (nucleic acid testing) is recommended for perinatally exposed children 18 months of age or older who have not been previously tested.
Panagiotakopoulos and colleagues acknowledge that perinatal exposure of infants born to pregnant women can detect HCV RNA, but Panagiotakopoulos and colleagues acknowledge that such detection is not always available during pregnancy.
“The uptake of HCV screening during pregnancy is evolving as recommendations have recently shifted from risk-based to universal screening,” they commented.
what you should know
- CDC emphasizes the importance of testing all perinatally exposed infants 2 to 6 months of age for hepatitis C virus (HCV) using nucleic acid testing (NAT).
- Infants and children with undetectable HCV RNA at or beyond 2 months of age do not require further follow-up unless clinically necessary, thus simplifying interventions for those who do not test positive.
- The recommendations highlight factors that influence HCV transmission, such as association with poorly controlled HIV co-infections, the impact of HIV antiretroviral therapy during pregnancy, and aspects of delivery.
Panogiotakopoulos and colleagues noted that HIV co-infection is transmitted more frequently when HIV co-infection is poorly controlled, which may be more common among pregnant women who inject drugs. They also showed that the use of antiretroviral therapy during pregnancy to reduce HIV viral load was associated with reduced rates of perinatal hepatitis C virus transmission.
Several aspects of transmission were considered, including the increased risk of HCV transmission with rupture of membranes lasting more than 6 hours before delivery and the use of intrafetal monitoring. Panogiotakopoulos and colleagues also noted that when invasive testing is required, amniocentesis is generally recommended rather than chorionic villus sampling.
They noted that there is no evidence that caesarean section is any less likely than vaginal delivery to prevent perinatal hepatitis C virus transmission. Postpartum breastfeeding also does not increase the risk of HCV transmission unless the nipples are cracked or bleeding.
Recognizing that cost is a barrier to treatment, recommendations include cost-effectiveness calculations: costs and health outcomes of various testing strategies, including spontaneous clearance of infection. Outcomes included diagnosis of infection, treatment or cure of infection, hepatocellular carcinoma, liver transplantation, and liver-related death. In multiple modeling studies, NAT (nucleic acid testing) for HCV RNA in infants with known perinatal exposure at 2 to 6 months of age was identified to achieve cost savings and improved health outcomes.
“There is a need to better understand how to improve linkage to care for these infants. Specifically, barriers to testing and the reasons why children who are not tested and identified are not referred to appropriate providers for follow-up,” urge Panogiotakopoulos and colleagues .
refer to
1. Panagiotakopoulos L, Sandul AI, Conners EE, et al. CDC recommendations for hepatitis C testing in perinatally exposed infants and children—United States, 2023. millimeter wave radar. 2023;72(4):1-19.