Universal Hepatitis C Virus Screening Research Articles

Differences in inpatient and outpatient hepatitis C virus prevalence and linkage to care rates in a safety net hospital hepatitis C screening program.

Routine screening for hepatitis C virus (HCV) infection is crucial in identifying the 50% of infected persons unaware of their infection. We added an inpatient screening initiative to our successful outpatient HCV screening program in an urban, safety-net hospital. From March 2017 to December 2019, HCV screening was performed in inpatient and outpatient settings at Grady Health System. We compared care cascade outcomes, including anti-HCV testing, RNA testing, and linkage to care (LTC) between these settings. A total of 29751 patients were tested for anti-HCV: 8883 inpatients and 20868 outpatients. The anti-HCV population was predominantly Black (76.2%) and male (67.9%). The total anti-HCV prevalence was 8.9%, with 14% of inpatients and 6.7% of outpatients testing positive. RNA testing was performed on 86%. The prevalence of active HCV infection was 59.3% in those that were anti-HCV positive; inpatient prevalence was 66%, and outpatient was 53.8%. Of those with active infection, 67.5% were linked to care (57.3% of inpatients and 77.8% of outpatients). We found significant differences in prevalence of anti-HCV and LTC rates between inpatients and outpatients during an HCV screening program. Higher anti-HCV prevalence among inpatients may be due a higher prevalence of non-birth year HCV risk factors. LTC rates were lower in the inpatient setting despite a robust linkage strategy. The striking prevalence of HCV in both settings warrants continued screening, expansion to additional settings, and novel strategies to improve inpatient linkage rates, especially in the setting of new universal HCV screening guidelines.

1073. The Time is Now for Rapid Initiation of Hepatitis C Virus (HCV) Treatment

BackgroundAn estimated 65,000 New Mexicans are infected with HCV, accounting for ~3% of the state’s population with intravenous drug use being the most common risk factor for the acquisition of HCV. In 2020, the US Preventive Service Task Force recommended universal HCV screening for all adults aged 18 to 79 years old. HCV screening requires a two-step process involving a HCV antibody (Ab) test followed by a confirmatory HCV ribonucleic acid (RNA) test to detect active infection. Acute HCV infections are typically asymptomatic leaving many individuals unaware of their diagnosis for years. New Mexico was one of the first states to abandon the requirement for specialist referral, fibrosis staging, and abstinence from substance abuse to facilitate HCV treatment. Despite removal of these barriers, major gaps in access to HCV treatment still persist. The objective was to develop a HCV connect-to-care cascade for the University of New Mexico Hospital (UNMH) to understand the potential barriers preventing patients from receiving appropriate care.MethodsThis was a retrospective, single center, descriptive study conducted at UNMH, a level 1 trauma, tertiary care academic medical center with 527 beds. All patients with a positive HCV Ab, RNA, or genotype obtained in 2018 were included in this study. There were no exclusions.ResultsIn 2018, over 11,000 unique patients received HCV testing in any form resulting in a total of 14,566 HCV tests being performed.2018 UNMH Connect-to-Care Cascade ConclusionOf the patients who screened positive, only 61.7% were referred for treatment, representing the largest gap in the cascade. However, once patients were seen in the clinic, 88.5% completed treatment with 100% having sustained virologic response (SVR). With the pan-genotypic HCV treatments having fewer side effects and high clinical success rates, it’s feasible that HCV treatment may no longer require a specialist. Similar to the rapid initiation of antiretrovirals in newly diagnosed HIV patients, where immediate access to treatment within days of diagnosis resulted in improved retention in care, decreased time to viral suppression, and decreased viral transmission, rapid initiation of HCV treatment may be the wave of the future.Disclosures All Authors: No reported disclosures

Innovations in Hepatitis C Screening and Treatment.

New therapies offer hope for a cure to millions of persons living with hepatitis C virus (HCV) infection. HCV elimination is a global goal that will be difficult to achieve using the traditional paradigms of diagnosis and care. The current standard has evolved toward universal HCV screening and treatment, to achieve elimination goals. There are several steps between HCV diagnosis and cure with major barriers along the way. Innovative models of care can address barriers to better serve hardly reached populations and scale national efforts in the United States and abroad. Herein, we highlight innovative models of HCV care that aid in our progress toward HCV elimination.

Routine Screening and Linkage to Care for Hepatitis C Virus in an Urban Safety-Net Health System, 2017-2019.

Hepatitis C virus (HCV) is a major threat to public health in the United States. We describe and evaluate an HCV screening and linkage-to-care program, including emergency department, inpatient, and outpatient settings, in an urban safety-net health system in Chicago. Sinai Health System implemented a universal HCV screening program in September 2016 that offered patient navigation services (ie, linkage to care) to patients with a positive result for HCV on an RNA test. We collected data from February 1, 2017, through January 31, 2019, on patient demographic characteristics, risk factors, and various outcomes (eg, number of patients screened, test results, proportions of new diagnoses, number of patients eligible for patient navigation services, and proportion of patients who attended their first medical appointment). We also examined outcomes by patients' knowledge of infection. Of 21 018 people screened for HCV, 6% (1318/21 018) had positive test results for HCV antibody, 68% (878/1293) of whom had positive HCV RNA test results. Of these 878 patients, 68% were born during 1945-1965, 68% were male, 65% were Black, 19% were Latino, 55% were newly diagnosed, and 64% were eligible for patient navigation services. Risk factors included past or current drug use (53%), unemployment (30%), and ever incarcerated (21%). Of 562 patients eligible for navigation services, 281 (50%) were navigated to imaging services, and 203 (72%) patients who completed imaging attended their first medical appointment. Patient navigation played a critical role in linkage success, but securing stable, long-term financial support for patient navigators is a challenge.

Hepatitis C Seroprevalence Among Consecutive Labor and Delivery Admissions in Two New York City Hospitals.

BackgroundRates of hepatitis C virus (HCV) among women of childbearing age have increased as a result of the opioid epidemic, especially in the nonurban white population. Recently updated US Preventative Services Task Force and Centers for Disease Control and Prevention guidance have recommended universal HCV screening during pregnancy, but obstetrics societies have not yet endorsed this recommendation. We evaluated the seroprevalence of HCV among pregnant women in an inner-city population, compared rates with other sexually transmitted infections (STIs) screened for during pregnancy, and evaluated factors associated with HCV positivity.MethodsWe performed a prospective seroprevalence study of consecutive labor and delivery admissions (both antepartum complications and delivery admissions) by testing serum samples for HCV antibody over 9 months at 2 major hospital settings in New York City.ResultsFifty-six of 7373 (0.75%; 95% confidence interval [CI], 0.57–0.98) patients screened positive for HCV, with 28 of 4013 (0.70%; 95% CI, 0.46%–1.01%) and 28 of 3413 (0.82%; 95% CI, 0.55%–1.18%) at each hospital. Forty-one percent of HCV-positive patients had any reported HCV risk factors. Hepatitis C virus-positive patients were less likely to have private insurance and more likely to have a history of cannabis, cocaine, and injection drug use (P < .001). The HCV rates were higher among antepartum admissions compared with delivery admissions and higher than that of hepatitis B virus (0.65%; 95% CI, 0.48–0.86), human immunodeficiency virus (0.27%; 95% CI, 0.16–0.42), and syphilis (0.16%; 95% CI, 0.08–0.28).ConclusionsWe found a higher than expected HCV seroprevalence among pregnant women and higher than most other STIs routinely screened for in pregnancy. Most patients had no risk factors. These findings support universal screening for hepatitis C during pregnancy.

Epidemiology of Hepatitis C in Delaware.

Infection with hepatitis C virus (HCV) is pervasive throughout the United States of America as we fight the ongoing urban and rural opioid epidemics and rising rates of fatal and non-fatal overdoses. While risk factors for incident HCV abound, our country and the State of Delaware have increasing access to highly effective, short-course, curative HCV treatments. Despite unprecedented medical advances for HCV, as well as expanded HCV screening guidelines calling for universal adult HCV screening and screening during every pregnancy, the epidemiology of HCV at the national and statewide levels continues to be lacking. In attempting to gather, interpret, and present the highest quality available data, we conclude that HCV remains a pressing public and individual health concern for Delawareans, and our nation at large. We urge stakeholders in Delaware to make concerted efforts to fill in the many remaining gaps of HCV epidemiology in order to better inform public health resource allocation, educate the public and healthcare professionals regarding viral hepatitis, and ultimately improve the HCV care continuum, spanning from increasing rates of universal HCV screening and diagnosis to linkage to care to treatment initiation all the way to cure and beyond.

Screening Adult Children of Hepatitis C-Infected Baby Boomers: Barriers to Testing and Prevalence Estimates.

Screening Adult Children of Hepatitis C-Infected Baby Boomers: Barriers to Testing and Prevalence Estimates.

Is the universal population Hepatitis C virus screening a cost-effective strategy? A systematic review of the economic evidence.

ABSTRACTBackgroundEfficient strategies are needed in order to achieve the objective of the WHO of eradicating Hepatitis C virus (HCV). Hepatitis C infection can be eliminated by a combination of direct acting antiviral (DAA). The problem is that many individuals remain undiagnosed. The objective is to conduct a systematic review of the evidence on economic evaluations that analyze the screening of HCV followed by treatment with DAAs.MethodsEleven databases were performed in a 2015-2018-systematic review. Inclusion criteria were economic evaluations that included incremental cost-effectiveness ratio (ICER) in terms of cost per life year gained or quality-adjusted life year.ResultsA total of 843 references were screened. Sixteen papers/posters meet the inclusion criteria. Ten of them included a general population screening. Other populations included were baby-boomer, people who inject drugs, prisoners or immigrants. Comparator was “standard of care”, other high-risk populations or no-screening. Most of the studies are based on Markov model simulations and they mostly adopted a healthcare payer´s perspective. ICER for general population screening plus treatment versus high-risk populations or versus routinely performed screening showed to be below the accepted willingness to pay thresholds in most studies and therefore screening plus DAAs strategy is highly cost-effective.ConclusionThis systematic review shows that screening programmes followed by DAAs treatment is cost-effective not only for high risk population but for general population too. Because today HCV can be easily cured and its long-term consequences avoided, a universal HCV screening plus DAAs therapies should be the recommended strategy to achieve the WHO objectives for HCV eradication by 2030.

Prenatal Hepatitis C Screening in Kentucky: Does a Change in the Law Change Clinical Practice? [14A

INTRODUCTION: Prevalence of hepatitis C virus (HCV) infection among pregnant women is highest in Kentucky. ACOG endorses a risk-based approach for prenatal HCV screening; however gaps in identification can occur. In 2018, Kentucky became the first state nationwide to legislatively mandate universal HCV screening for all pregnant women. METHODS: This retrospective study evaluates trends of prenatal HCV testing before and after a universal HCV screening requirement. Women with an ICD-9/ICD-10 code indicating delivery at UK Healthcare (UKHC) in 2016 through 2018 were identified; those with laboratory results for HBsAg in the 10 months prior to delivery were considered to have had prenatal care within UKHC and included in the study cohort. Electronic medical records were reviewed to identify maternal characteristics and anti-HCV test results. RESULTS: Among 5,616 women with deliveries, 3,869 (69%) had documentation of prenatal HBsAg testing and included in the study cohort. Of these, 48 (1.2%) had a diagnosis of HCV infection and an additional 716 (19%) had prenatal anti-HCV testing. Among women screened for HCV, 179 (25%) were anti-HCV positive. A total of 363 women in the cohort had a diagnosis indicating illicit drug use; 53 (15%) were neither tested for HCV nor had an existing HCV diagnosis. Prevalence of prenatal HCV screening increased significantly from 18% at baseline to 31% among women who delivered after the universal screening legislation became effective (P&lt;.0001). CONCLUSION: A significant increase in HCV testing was observed following the universal HCV screening legislation, however testing uptake remained low. Efforts to improve implementation are warranted.

Strategies to identify hepatitis C virus infection in patients receiving anticancer therapy: a cross-sectional study.

Optimal hepatitis C virus (HCV) screening strategies for cancer patients have not been established. We compared the performance of selective HCV screening strategies. We surveyed patients presenting for first systemic anticancer therapy during 2013-2014 for HCV risk factors. We estimated the prevalence of positivity for HCV antibody (anti-HCV) and examined factors associated with anti-HCV status using Fisher's exact test or Student's t test. Sensitivity was calculated for screening patients born during 1945-1965, patients with ≥ 1 other risk factor, or both cohorts ("combined screening"). We enrolled 2122 participants. Median age was 59years (range, 18-91); 1138 participants were women. Race/ethnicity distribution was white non-Hispanic, 76% (n = 1616); Hispanic, 11% (n = 233); black non-Hispanic, 8% (n = 160); Asian, 4% (n = 78); and other, 2% (n = 35). Primary cancer distribution was non-liver solid tumor, 78% (n = 1664); hematologic cancer, 20% (n = 422); and liver cancer, 1% (n = 28). Prevalence of anti-HCV was 1.93% (95% CI, 1.39%-2.61%). Over 28% of patients with detectable HCV RNA were unaware of infection. Factors significantly associated with anti-HCV positivity included less than a bachelor's degree, birth in 1945-1965, chronic liver disease, injection drug use, and blood transfusion or organ transplant before 1992. A total of 1315 participants (62%), including 39 of 41 with anti-HCV, reported ≥ 1 risk factor. Sensitivity was 80% (95% CI, 65-91%) for birth-cohort-based, 68% (95% CI, 52-82%) for other-risk-factor-based, and 95% (95% 83-99%) for combined screening. Combined screening still missed 5% of patients with anti-HCV. These findings favor universal HCV screening to identify all HCV-infected cancer patients.

Respect women, promote health and reduce stigma: ethical arguments for universal hepatitis C screening in pregnancy

In the USA, there are missed opportunities to diagnose hepatitis C virus (HCV) in pregnancy because screening is currently risk-stratified and thus primarily limited to individuals who disclose history of...

A population-based screening for hepatitis C antibodies and active infection using a point-of-care test in a low prevalence area

BackgroundData on the true prevalence of hepatitis C virus (HCV) infection in the general population is essential. We evaluated a program implementing free universal HCV screening using a non-invasive point-of-care test (POCT) (OraQuick-HCV rapid test) in oral fluid in an urban area in Valencia, South-Eastern Spain.MethodsA cross-sectional study was performed during 2015–2017. Free HCV screening was offered by regular mail to 11,500 individuals aged 18 and over, randomly selected from all census residents in the Health Department. All responding participants filled in a questionnaire about HCV infection risk factors and were tested in their tertiary Hospital. In those with a positive POCT, results were confirmed by enzyme-immunoassay and HCV-RNA.Results1,206 persons agreed to participate (response rate: 11.16%). HCV antibodies were detected in 19 (1.60%) cases (age-sex standardized rate: 1.31%; 95%CI: 0.82–2.07), but only 8 showed positive HCV-RNA (age-sex standardized rate: 0.56%; 95%CI: 0.28–1.14). The majority (89%) of the cases were born before 1965 and 74% had at least one known risk factor for HCV infection. All anti-HCV positive individuals were already aware of their infection, and no undiagnosed cases were detected. The performance of the POCT was excellent for detecting active infection.ConclusionsThese preliminary data suggest that HCV population screening with a POCT is feasible but, in our setting, mailing recruiting is not effective (11% response rate). The low prevalence of HCV antibodies and active infection in the participant population (with no new diagnoses made) suggests that, in our setting, underdiagnosis may be uncommon.

Oncologic Implications of Chronic Hepatitis C Virus Infection.

Chronic hepatitis C virus (HCV) infection increases the risk for several types of cancer, including hepatocellular carcinoma (HCC) and B-cell non-Hodgkin lymphoma, as primary and second primary malignancies. HCV-infected patients with cancer, particularly those undergoing anticancer therapy, are at risk for development of enhanced HCV replication, which can lead to hepatitis flare and progression of liver fibrosis or cirrhosis. Risk factors for HCV infection include injection drug use, blood transfusion, or solid organ transplantation before 1992, receipt of clotting factor concentrates before 1987, long-term hemodialysis, chronic liver disease, HIV positivity, and occupational exposure. Widely available direct-acting antivirals are highly effective against HCV and well tolerated. Identification of HCV-infected individuals is the essential first step in treatment and eradication of the infection. One-time screening is recommended for persons born from 1945 to 1965; screening is also recommended for persons with risk factors. Recently, a public health recommendation has been drafted to screen all adults age 18 to 79 years. Two oncology organizations recommend screening all patients with hematologic malignancies and hematopoietic cell transplant recipients, and a recently published multicenter prospective study supports universal HCV screening for all patients with cancer. HCV screening entails testing for anti-HCV antibodies in serum and, when results are positive, HCV RNA quantitation to confirm infection. Direct-acting antiviral therapy eradicates HCV in almost all cases. Virologic cure of HCV prevents chronic hepatitis and progression to liver fibrosis or cirrhosis. HCV eradication also decreases the risk of developing HCV-associated primary and second primary malignancies, and it may allow HCV-infected patients access to important cancer clinical trials. Patients with HCV-related cirrhosis require lifelong surveillance for HCC, even after viral eradication.

308. Slow Adoption of a Nurse-Driven Protocol for Universal Hepatitis C Virus Screening in a Hospital Emergency Department: Lessons Learned

BackgroundIn areas with a high prevalence of hepatitis C virus (HCV) infection, emergency department (ED) visits may provide unique opportunities for screening. The catchment area for Hahnemann University Hospital (HUH) has an HCV seroprevalence rate of >20%. However, limited data exist addressing HCV testing strategies in the ED. This study describes the experience of piloting a nurse-driven HCV screening protocol in an urban hospital ED.MethodsA nurse-driven HCV screening protocol was developed and implemented on August 1, 2018. We performed a retrospective analysis of the protocol’s performance from July 1, 2018, through December 31, 2018. Patients who were evaluated in the ED and had blood collected were analyzed. We provided universal HCV screening regardless of age or risk factors. If HCV-positive by antibody screen and viral load confirmation, an attempt was made to link patients to care. Linkage was defined as having received an inpatient evaluation by either infectious diseases or hepatology physician.ResultsAmong 20,705 unique patients seen in the ED, 7841 (38%) had blood work collected. 821 (10.5%) patients had HCV antibody testing. After the implementation of the nurse-driven protocol, the testing rate increased from 68/1340 (5.1%) to 753/6501 (11.6%). 260 Baby Boomers (born between 1945–1965) were screened, of which 60 (23.1%) had positive screens. 561 non-Baby Boomers were screened, of which 30 (5.4%) had positive screens. Barriers of implementing nurse-driven protocol were: (1) multiple steps of the ordering process in the electronic medical record (EMR), (2) the complexity of staff schedules, and (3) staff concerns regarding the disclosure of HCV test results. Among the patients who were diagnosed with chronic HCV, 60 % were linked to care for treatment.ConclusionWe piloted a nurse-driven universal HCV testing protocol in the ED of a hospital with high HCV prevalence. Though the screening rate doubled, it was still low. We identified barriers that may be addressed to improve future screening rates. In areas with a high seroprevalence of HCV, universal screening may be an excellent public health intervention to identify asymptomatic HCV-infected patients.Disclosures All authors: No reported disclosures.

291. Using Individualized Provider Feedback to Improve HCV Screening in a High-Volume Emergency Department

BackgroundEnding the Hepatitis C Virus (HCV) epidemic requires HCV testing as the critical first step. Busy urban Emergency Rooms are uniquely suited for HCV screening programs but numerous barriers to effective program implementation exist. We describe an emergency room physician champion model that utilizes the feedback intervention theory (FIT) to providers to increase HCV screening rates.MethodsDue to the changing epidemiology of HCV in 2017 New York Presbyterian supported one-time universal HCV screening. In September 2018, our physician champion provided an educational session to ED providers about the importance of HCV screening and the proposed study. From the end of September to the end of March 2019, providers received a monthly e-mail from the ED champion and an automated text message with their individual and peer HCV screening rates. The number of HCV tests and percent of individuals with documented HCV testing in the ED was compared pre and post this intervention and to HCV testing in the inpatient and outpatient setting where feedback was not provided.ResultsOn average ED providers evaluated approximately 14,000 patients per month. HCV testing increased 1,600% from an average of 40 tests per month in the 18 months prior to the intervention to an average of 640 tests sent per month during the intervention. tests sent in December. This was compared with stable inpatient and outpatient HCV screening during the same time period.ConclusionIndividualized provider feedback paired with an ED physician champion can lead to a significant increase in HCV testing. Ongoing studies will determine if this intervention can lead to long-term behavior change. Disclosures All authors: No reported disclosures.

A Survey of Hepatitis C Virus (HCV) Screening in Pregnancy Among OBGYNs at a Tertiary Care Center [19Q

INTRODUCTION: Hepatitis C Virus (HCV) infection among pregnant women in the US increased 89% from 2009 to 2014. The risk of a HCV infected mother transmitting the infection to her infant is approximately 4-7% per pregnancy. Infectious Disease Society of America (IDSA) and American Association for the Study of Liver Diseases (AASLD) recommend universal HCV screening in pregnancy whereas the American College of Obstetricians and Gynecologists (ACOG) recommends risk-based screening. The objective of this study was to assess the opinions and clinical practice of OBGYN providers in a tertiary care center. METHODS: An electronic 10 question survey was approved by the Tufts Medical Center Institutional Review Board and emailed to providers. RESULTS: 38/41 (92.6%) provided responses and 17/38 (44.7%) were attendings, 4/38 (10.5%) were fellows, and 17/38 (44.7%) were residents. 16/37 (43.2%) of respondents agreed all pregnant women should be screened for HCV whereas 20/37 (54.1%) agreed that only pregnant women with risk factors for HCV should be screened. When asked about their clinical practice, 3/36 (8.3%) of respondents stated they do not screen pregnant patients for HCV, 5/36 (13.9%) screen all pregnant patients, and 28/36 (77.8%) screen patients based on their risk factors for HCV. CONCLUSION: Divergent guidelines, provider opinions, and clinical practice necessitate further research into universal HCV screening in pregnant patients. Future plans include an educational intervention on HCV for providers in the department followed by a chart review to determine the HCV detection rate before and after a change in practice to universal screening for HCV.

932. Universal Hepatitis C Virus Screening in a Tennessee Tertiary Care Emergency Department

BackgroundDespite hepatitis C virus (HCV) age cohort and risk factor screening recommendations, many at-risk individuals remain undiagnosed. Current screening practices may not adequately capture those at high risk for infection, especially in regions with increasing injection drug use (IDU). Universal HCV screening in a Tennessee tertiary care emergency department (ED) was introduced to help define regional epidemiology and to improve diagnosis and linkage to care.MethodsThis screening program was implemented in the Vanderbilt University Medical Center ED. Adult patients who underwent phlebotomy for clinical purposes were offered HCV screening. Samples were initially tested for HCV antibodies; if positive, samples were reflexed for HCV RNA testing. Patients with positive HCV RNA tests (i.e., active HCV infection) were notified, counseled, and offered linkage to care.ResultsA total of 11,637 screening tests were performed between April 1, 2017 and March 31, 2018, with 1,008 (8.7%) HCV antibody positive and 488 (4.2%) RNA positive. Of note, 81 (0.7%) were HCV antibody positive but RNA testing could not be performed due to insufficient sample volume. Several notable populations had high rates of HCV (Table 1). Importantly, 3.9% of people not born between 1945 and 1965 were HCV RNA positive, and they were the majority (63.5%) of patients with active HCV (Table 2). A minority (31.6%) of those with active HCV had a known history of IDU (Table 2).ConclusionHCV is common among patients presenting for emergency care at a Tennessee tertiary care ED. Universal screening identified many infections that would have been missed using age cohort and risk factors alone. ED HCV screening may be a useful method to augment guideline-based testing and intervene among populations not consistently screened.Table 1:Notable Groups Screened for HCV (n = 11,537)DemographicsTotal ScreenedHCV Antibody + (%)HCV RNA + (%)People Born 1945–19653,670436 (11.9%)178 (4.9%)People Not Born 1945–19657,967572 (7.2%)310 (3.9%)Women Age 18–452,622156 (5.9%)77 (2.9%)Table 2:Demographics Among HCV RNA + (n = 488)Demographicsn (%)People Born 1945–1965178 (36.5%)People Not Born 1945–1965310 (63.5%)Women Age 18–4577 (15.8%)Known IDU154 (31.6%)People Not Born 1945–1965 With No Known IDU179 (36.7%)Disclosures C. A. Chastain, Gilead Sciences, Inc.: Grant Investigator and Research Contractor, Grant recipient and Research support. J. Johnson, Gilead Sciences, Inc.: Grant Investigator, Grant recipient. K. Miller, Gilead Sciences, Inc.: Grant Investigator, Grant recipient. J. H. Han, Gilead Sciences, Inc.: Grant Investigator, Grant recipient. W. H. Self, Gilead Sciences, Inc.: Grant Investigator, Grant recipient.

Risk-Based Hepatitis C Screening in Pregnancy Is Less Reliable Than Universal Screening: A Retrospective Chart Review.

Current guidelines recommend only hepatitis C virus (HCV) risk-based screening during pregnancy. We examined screening practices at a major medical center and found inconsistent risk-based screening and the presence of HCV among women with no known risk factors. We make a case for the implementation of universal HCV screening during pregnancy.

Chronic hepatitis C virus infection and neurocognitive function in adult survivors of childhood cancer.

Cancer survivors transfused with blood products before reliable screening for hepatitis C virus (HCV) are at risk for infection. This study examined the impact of HCV on neurocognitive function and health-related quality of life (HRQOL) among adult survivors of childhood cancer. Neurocognitive testing was conducted for 836 adult survivors of childhood cancer (mean age, 35 years [standard deviation, 7.4 years]; time since diagnosis, 29 years [standard deviation, 6.2 years]) who received blood products before universal HCV screening. No differences were observed between confirmed HCV-seropositive survivors (n = 79) and HCV-seronegative survivors (n = 757) in the primary diagnosis or neurotoxic therapies. Multivariate regression models were used to compare functional outcomes between seropositive and seronegative survivors. Compared with seronegative survivors, seropositive survivors demonstrated lower performance on measures of attention (P < .001), processing speed (P = .008), long-term verbal memory (P = .01), and executive function (P = .001). After adjustments for sex, age at diagnosis, and treatment exposures, seropositive survivors had a higher prevalence of impairment in processing speed (prevalence ratio [PR], 1.3; 95% confidence interval [CI], 1.1-1.6) and executive functioning (PR, 1.3; 95% CI, 1.1-1.6). Differences were not associated with the treatment of HCV or the presence of liver cirrhosis. Seropositive survivors reported worse general HRQOL (PR, 1.6; 95% CI, 1.2-2.1), which was associated with the presence of liver cirrhosis (P = .001). Survivors of childhood cancer with a history of HCV infection are at risk for neurocognitive impairment and reduced HRQOL beyond the known risks associated with neurotoxic cancer therapies. Cancer 2017;123:4498-505. © 2017 American Cancer Society.

P3.240 Does the Prevalence of Sexually Transmitted Diseases Adequately Reflect Sexual Transmission of Hepatitis C in the HIV-Infected Population?

BackgroundRecent data suggest sexual transmission of hepatitis C virus (HCV). However, data on the association between HCV and sexually transmitted disease (STD) prevalence are limited.MethodsThis was a retrospective cohort study...