115 Screening and infection rates for hepatitis C virus (HCV) in pregnancy with opiate use disorder

Abstract

American College of Obstetricians and Gynecologist recently updated recommendation for universal hepatitis C virus (HCV) screening during pregnancy. Previously, HCV screening was recommended in high risk populations. We sought to determine if recommended HCV screening in women with opiate use disorder (OUD) led to appropriate evaluation of HCV infection in pregnant women. This is a retrospective cohort study of pregnant women requiring inpatient management opioid use at a tertiary referral hospital in Pennsylvania identified by ICD-9 coding from 2011-2018. Readmission encounters during the same pregnancy were excluded. HCV antibody, HCV RNA, AST, and ALT test results as well as participant’s knowledge of prior HCV infection were extracted from the electronic medical record. Of the 200 women had detailed chart reviews, 167 were tested for HCV antibody (83%) and 117 (70%) had positive test results. In women who tested positive for HCV, 94 (80%) had no prior knowledge of HCV infection. For those with positive HCV Ab only 30% (35) had viral load assessment on admission or during their current pregnancy and liver enzymes were assessed in 28% (n=33) of patients. In women who were appropriately tested for liver function, 21% had transaminitis (ALT > 54 and/or AST >41) regardless of symptomatology. Pregnant women with OUD have high rates of HCV, screening during pregnancy identifies the diagnosis. Only a minimum of patients identified as having HCV are appropriately evaluated for viral burden and liver function. Despite recommendations for screening, there remains gaps in care in screening and appropriate evaluation for HCV.