Prevention of Hepatitis C in Women1

Abstract

Hepatitis C is a major public health problem in the United States. Although the incidence of new infections declined substantially in the past decade, approximately 25,000 persons are infected each year. In total, an estimated 2.7 million Americans have chronic hepatitis C virus (HCV) infection and are at risk for HCV-related chronic liver disease and hepatocellular carcinoma (HCC). The most common exposure associated with HCV infection is use of injection drugs. Other less commonly identified risk factors include sexual contact; transfusions before blood screening was implemented; and occupational, nosocomial, and perinatal exposures. Although sources of HCV infection are the same for men and women, the overall prevalence of HCV infection is lower among women than men, which is likely related to the lower prevalence of injection-drug use among women. The risk for HCV transmission from mother to infant is about 5%–6%; transmission occurs only from women who are HCV RNA positive and is higher among those coinfected with HIV (≈18.7%) than among women not infected with HIV (≈5.4%). The influence of factors such as maternal viral titer and interventions at the time of delivery is unclear. Studies indicate that breastfeeding is not a risk factor for perinatal transmission. Most hepatitis C prevention strategies are gender neutral and include screening and testing donors of blood, plasma, organ, tissue, and semen; virus inactivation of plasma-derived products; effective infection control practices; identification, counseling, and testing of at-risk persons; and medical management of infected persons. Pregnant women with risk factors for infection should be identified, screened, and counseled regarding the risk for perinatal transmission.