Earlier Testing of Infants With Perinatal Hepatitis C Exposure: A Key Step Toward Elimination.

Abstract

Hepatitis C virus (HCV) infection continues to be a major national public health problem and is targeted for domestic and global elimination. Driven by the ongoing opioid epidemic, HCV incidence has been rising in the US over the last decade with highest infection rates among young adults including women of childbearing age.1 This is significant because if these young adults with HCV viremia get pregnant, their infants are perinatally exposed to the virus. In 2020 as part of a strategy to increase testing of all adults, the Centers for Disease Control and Prevention (CDC) recommended universal HCV antibody screening with every pregnancy, a critical first step to improve maternal health and enhance identification of infants at risk for HCV.2 With a 3-8% risk, perinatal transmission is still the most common route of HCV infection among children and an increasing number of infants have been infected over recent years.3 Most infants with HCV infection are asymptomatic, so the diagnosis depends on subsequent testing of perinatally exposed infants to rule out infection. Historically, it was recommended that all infants with HCV exposure be screened for anti-HCV antibodies at ≥18 months. With this prior recommendation, numerous studies consistently demonstrated that 75-90% of exposed infants were never tested or linked to care.4,5 The reasons for this poor test rate are multifactorial, but a recommendation to wait 18 months in a population who often has many complicated social factors certainly was a major factor.4,5.