Anthony Martinez, MD: Screening guidelines have varied over the years. I mean, we’re all familiar with this. Things have changed a lot. Nancy, how are we doing with screening now? What are the current recommendations?
Nancy Rowe, MD: We are closer than ever to universal screening. So from the age of 17 to 79, you should get screened. If you have ongoing risk factors, you will need ongoing screening. Now they’re keeping this a little gray, but I think most of us see high-risk individuals on the screen at least once a year. Additionally, if there are abnormalities (lab work) or recent risk factors, you will be screened again. It is also very important that Tipu V. Khan, MD) said, as we emphasize, capture these individuals while they are regularly receiving health care. So it’s a little bit controversial, but screening for every pregnancy is now added to the screening guidelines. Not because pregnancy is a risk factor, not because we use hepatitis C treatments to reduce maternal-to-child transmission, (but) because we recognize this bimodal distribution, this younger group of individuals, is now almost equal Opportunity. Infection rates among men and women are nearly identical. It’s still male-dominated, but when you’re pregnant, people have health insurance, invest in their own health, and if you can identify that they have hepatitis C, then connect them with people who can help eradicate it. Viruses, even after pregnancy, are a very important place to be.
Anthony Martinez, MD: I think that’s really a key thing. We are already seeing changes in the demographics of people with hepatitis C. In terms of new cases or accident cases, there is a clear skew towards younger people, and there is also a change in terms of gender. In my own clinic, we have the highest rates of hepatitis C among women of childbearing age that I have ever seen. We have a significant proportion of pregnant women with hepatitis C. So basically, we’re pretty much moving toward universal screening of people 17 and older. We still see some teenagers, so a lot of us still see teenagers taking addictive drugs or whatnot. Can you talk to us about the risk factors? Because for the 17-year-old group, we still need to screen based on risk. Can you talk about some of those risk factors?
Nancy Rowe, MD: Well, I think we’ve established the fact that injection drug use is a risk factor. Tattooing used to be a risk factor, but now most tattoos are done where both the needle and the ink are clean. So I think tattoos are universal, and their connection to hepatitis C doesn’t have the same sparkle. But I think it’s really important, not just the risk factors, but to think about maternal child transmission, pediatric hepatitis C, not necessarily adolescents, but pediatric hepatitis C is driven by mother-to-child transmission. This is not common. About 5% are mono-infected and 10% are co-infected with HIV. But most children with hepatitis C get the infection from their mothers. When you look at the guidance, our screening guidance also states that if your mother has hepatitis C, you need to be screened. This doesn’t mean babies, but all babies. If your mom is 70 years old and you find out she has hepatitis C and you happen to be 40, you should get screened. You are still her child. So I think when we talk about pediatric hepatitis C, (it’s about) identifying a positive mother doesn’t capture just one child, it captures all children. And how to extend that beyond the pediatric time point. The transition through adolescence will again be based on risk. I think most of us have kids. As a parent, it can be difficult to look inward and understand that your child might be doing anything but learning algebra. But we don’t yet have clear guidance on how to identify these risk factors when you go to your pediatrician. But I think pediatricians are doing a better job of asking parents to step aside, talk about high-risk behaviors, and hopefully follow up with appropriate screening.
Anthony Martinez, MD: Yes, some things can be affected by non-injection drug use, sexual contact, exposure, etc. Nancy, the guidelines are pretty simple now. This is almost universal. The guidance seems to have stalled and it’s not necessarily clear, which tests should we use? For our viewers, what tests do they have available to screen these patients?
Nancy Rowe, MD: Our guidelines may not be as clear as they should be. Part of it is the amount of testing required to get your drug approved in some states, as well as an outdated view of what you might think you need. Our lab has simplified things so even if you order the wrong test, you’ll still get the right answer. But screening should be done with hepatitis C antibodies. If the result is positive, it is expected to be automatically reflected in the PCR (polymerase chain reaction test). If you have had hepatitis C in the past and cleared it on its own or have been treated, you should get a PCR test. But if you get the antibody, it’s going to be positive, and then it should reflect on the PCR. So I think when we look at our care cascade, one of the most important changes is that we move things to the lab so that even if the clinician doesn’t order the right test, the lab will typically order the right test.
Anthony Martinez, MD: So ideally we use reflection testing. This may not be available everywhere. It would be good to do an antibody test if necessary, and if it’s positive, then we obviously have the viral load. So, it could be a two-step process, but it could also become a one-step process.
The transcript was generated by artificial intelligence and has been edited for clarity.