The Centers for Disease Control and Prevention (CDC) have issued new guidelines advocating for the testing of all perinatally exposed infants and children for the Hepatitis C Virus (HCV). These guidelines also propose that positive cases be referred for appropriate care and curative treatments which are approved for children as young as three years old.
Lakshmi Panagiotakopoulos, MD, of the Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and Tuberculosis Prevention, CDC, and her team have strongly endorsed these measures as they are vital for the eradication of Hepatitis C. The team laid out four main recommendations intended to address the surge in HCV incidence among reproductive-age individuals throughout the last decade, as well as the worrying percentage of perinatally exposed infants and children afflicted with HCV infection. These recommendations work in tandem with the universal Hepatitis C screening guidelines for adults released in 2020, which encourage regular testing for pregnant women during each pregnancy. The guidelines also review and update the testing techniques and their timing as per the advancements in technology since 1998.
The team notes the inconsistent testing of pregnant persons for HCV RNA, leading to perinatal exposure in infants. They assert that this may stem from the recent shift from risk-based to universal screening, leading to a transition period for the uptake of HCV screening during pregnancy. The researchers also noted several factors contributing to HCV transmission, such as poorly controlled HIV co-infections which are more common in pregnant persons who inject drugs, and the increased risk with lengthy membrane ruptures before delivery or the use of internal fetal monitoring. The team strongly suggested conducting cost-effectiveness calculations to point out that cost remains a significant barrier to treatment.
The studies concluded that testing infants known to have perinatal exposure through a nucleic acid test (NAT) for HCV RNA at ages between 2 to 6 months can simultaneously achieve cost savings and improved health outcomes. They stressed the need for a better understanding of how to bridge the gap between detection and proper healthcare for these infants, and the much-needed identification of barriers to testing and the reasons behind lacking follow-up after identification.