Original Article

Increasing Prevalence of Chronic Hepatitis C Virus Infection in a Southern Academic Obstetrical Clinic

Authors: Gweneth B. Lazenby MD, Cody Orr BA, Constance Guille MD, Eric G. Meissner MD, PhD

Abstract

Objectives: The opioid epidemic has resulted in rising rates of hepatitis C virus (HCV) infection in women of childbearing age. With this changing epidemiology in mind, the Infectious Diseases Society of America/American Association for the Study of Liver Diseases guidelines were updated in 2018 to recommend screening all pregnant women for HCV infection, irrespective of risk factors. Because HCV infection can affect maternal-fetal health and result in vertical transmission, presentation for pregnancy-related medical care represents an opportunity to diagnose and manage HCV infection, as well as prepare for treatment postpartum.

Methods: We performed a retrospective chart review spanning 2007–2016 to examine the epidemiology of HCV infection and opioid use disorder in a southern academic obstetrical clinic and to explore the impact of new screening guidelines if implemented. Composite data from the electronic health record and individual chart review were used to determine rates of HCV infection and opioid use disorder in obstetrics, explore patient demographics, and examine perinatal outcomes.

Results: Rates of both opioid use disorder and chronic HCV infection increased significantly during the 10-year period of analysis. Patients diagnosed as having chronic HCV infection were primarily white (95%) and there was no observed impact of HCV on perinatal outcomes. HCV testing in pregnancy, even when patients had documented opioid use disorder, was infrequent (0.7% of all pregnancies). Documented follow-up for HCV postpartum for both mothers and infants was incomplete, with only one-third of identified HCV-exposed infants referred and only 9% receiving HCV testing at our institution.

Conclusions: HCV prevalence increased between 2007 and 2016, but screening and treatment of HCV in this southern obstetrical cohort was infrequent. The implementation of universal screening in pregnancy will likely identify additional cases, and an improved cascade of care will be necessary to address the HCV epidemic.

 
Posted in: Gastroenterology19

This content is limited to qualifying members.

Existing members, please login first.

If you have an existing account please login now to access this article or view your purchase options.

Purchase only this article ($15)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. World Health Organization. Hepatitis C fact sheet. https://www.who.int/news-room/fact-sheets/detail/hepatitis-c. Accessed April 6, 2019.
2. Hughes BL, Page CM, Society for Maternal-Fetal Medicine.et al. Hepatitis C in pregnancy: screening, treatment, and management. Am J Obstet Gynecol 2017;217:B2-B12.
3. Koneru A, Nelson N, Hariri S, et al. Increased hepatitis C virus (HCV) detection in women of childbearing age and potential risk for vertical transmission-United States and Kentucky, 2011-2014. MMWR Morb Mortal Wkly Rep 2016;65:705-710.
4. Patrick SW, Bauer AM, Warren MD, et al. Hepatitis C virus infection among women giving birth-Tennessee and United States, 2009-2014. MMWR Morb Mortal Wkly Rep 2017;66:470-473.
5. Ly KN, Jiles RB, Teshale EH, et al. Hepatitis C virus infection among reproductive-aged women and children in the United States, 2006 to 2014. Ann Intern Med 2017;166:775-782.
6. Floreani A. Hepatitis C and pregnancy. World J Gastroenterol 2013;19:6714-6720.
7. Huang QT, Huang Q, Zhong M, et al. Chronic hepatitis C virus infection is associated with increased risk of preterm birth: a meta-analysis of observational studies. J Viral Hepat 2015;22:1033-1042.
8. Pergam SA, Wang CC, Gardella CM, et al. Pregnancy complications associated with hepatitis C: data from a 2003-2005 Washington state birth cohort. Am J Obstet Gynecol 2008;199:38e1-38e9.
9. Money D, Boucoiran I, Wagner E, et al. Obstetrical and neonatal outcomes among women infected with hepatitis C and their infants. J Obstet Gynaecol Canada 2014;36:785-794.
10. Stokkeland K, Ludvigsson JF, Hultcrantz R, et al. Pregnancy outcome in more than 5000 births to women with viral hepatitis: a population-based cohort study in Sweden. Eur J Epidemiol 2017;32:617-625.
11. Ly KN, Xing J, Klevens RM, et al. The increasing burden of mortality from viral hepatitis in the United States between 1999 and 2007. Ann Intern Med 2012;156:271-278.
12. Kohli A, Shaffer A, Sherman A, et al. Treatment of hepatitis C: a systematic review. JAMA 2014;312:631-640.
13. American College of Obstetrics and Gynecologists. ACOG Practice Bulletin No. 86: viral hepatitis in pregnancy. Obstet Gynecol 2007;110:941-956.
14. Committee on Obstetric Practice. Committee Opinion No. 711: opioid use and opioid use disorder in pregnancy. Obstet Gynecol 2017;130:e81-e94.
15. Boudova S, Mark K, El-Kamary SS. Risk-based hepatitis C screening in pregnancy is less reliable than universal screening: a retrospective chart review. Open Forum Infect Dis 2018;5:ofy043.
16. Fernandez N, Towers CV, Wolfe L, et al. Sharing of snorting straws and hepatitis C virus infection in pregnant women. Obstet Gynecol 2016;128:234-237.
17. Epic. SlicerDicer Setup and Support Guide. Verona, WI : Epic 2015. Available at: www.epic.com.
18. Annibale DJ, Hulsey TC, Wallin LA, et al. Clinical diagnosis and management of respiratory distress in preterm neonates: effect of participation in a controlled trial. Pediatrics 1992;90:397-400.
19. Krans EE, Zickmund SL, Rustgi VK, et al. Screening and evaluation of hepatitis C virus infection in pregnant women on opioid maintenance therapy: a retrospective cohort study. Subst Abus 2016;37:88-95.
20. Frimpong JA. Missed opportunities for hepatitis C testing in opioid treatment programs. Am J Public Health 2013;103:1028-1030.
21. Epstein R, Wang J, Mayer K, et al. HCV screening practices among adolescents and young adults in a national sample of federally qualified health centers in the U.S. https://idsa.confex.com/idsa/2018/webprogram/Paper71294.html. Accessed April 6, 2019.
22. Jhaveri R, Broder T, Bhattacharya D, et al. Universal screening of pregnant women for hepatitis C: the time is now. Clin Infect Dis 2018;67:1493-1497.
23. Trivedi S, Williams C, Torrone E, et al. National trends and reported risk factors among pregnant women with syphilis in the United States, 2012-2016. Obstet Gynecol 2019;133:27-32.
24. Slutsker JS, Hennessy RR, Schillinger JA. Factors contributing to congenital syphilis cases-New York City, 2010-2016. MMWR Morb Mortal Wkly Rep 2018;67:1088-1093.
25. Nesheim S, Harris LF, Lampe M. Elimination of perinatal HIV infection in the USA and other high-income countries: achievements and challenges. Curr Opin HIV AIDS 2013;8:447-456.
26. Kuncio DE, Newbern EC, Johnson CC, et al. Failure to test and identify perinatally infected children born to hepatitis C virus-infected women. Clin Infect Dis 2016;62:980-985.