Letter: universal screening for hepatitis C in pregnant women, children and adolescents

Abstract

EDITORS, We read with interest the systematic review with metaanalysis by Indolfi that discussed the efficacy and safety of directacting antivirals (DAAs) in children and adolescents with chronic hepatitis C virus (HCV) infection.1 The authors demonstrated that these population can be safely treated with similar efficacy as reported in adults. Indeed, the advent of highly effective oral DAA therapy is the most significant advance in the treatment of HCV in decades and now allows us to cure chronic HCV. A big challenge is to identify all individuals with HCV infection and to find the means to treat them. Vertical transmission occurs in 5.8% of infants born to women who are infected only with HCV and in up to twice as many infants born to women who are also infected with HIV or who have high HCV viral loads.2 The incidence of HCV infection has been increasing in young individuals, including women of childbearing age. Approximately 1700 infected infants are born annually to 29 000 HCVinfected mothers.3 From 2011 to 2014, the proportion of infants born to HCVinfected women in the United States increased by 68%.4 Screening pregnant women during each pregnancy benefits both the mother and the infant. Indeed, many women only have access to healthcare during pregnancy, which might be an opportune time to screen for HCV while simultaneously receiving antenatal pathogen testing. Identification of HCV infection during pregnancy can inform pregnancy and delivery management issues that might reduce the likelihood of HCV transmission to the infant.5 Although DAAs are not yet approved for use in pregnancy, the postpartum period represents a unique time for the treatment of women who have had HCV infection diagnosed during pregnancy. In addition, treatment reduces the transmission risk during subsequent pregnancies. Chaillon et al assessed the costeffectiveness of offering HCV antenatal rescreening for women in the United States screened during a prior pregnancy and without evidence of past HCV exposure, using a previously published model.6 They showed that universal HCV rescreening among pregnant women was costeffective. Another argument to screening in each pregnancy is that an inordinate amount of time could be spent trying to assess whether a new patient in an obstetric practice had received her onetime HCV screening in a prior pregnancy. Given the many screening tests performed during antenatal care for each pregnancy, the addition of HCV to this test menu seems a practical way to ensure that screening actually happens. Compared with adults, there has been little attention paid to HCV screening in children and adolescents. Injection drug use and other risky behaviour that increases the chances for HCV infection do not start at 18 years of age. In fact, recent data indicate a worrisome increase in HCV infection among young persons who inject drugs.7 As DAAs are effective in most children and adolescents with chronic HCV infection,1 they could be screened as part of school physicals and promptly referred for HCV treatment.