Is it Time for Universal Prenatal Hepatitis C Screening?

BACKGROUND AND PURPOSE:

• SMFM recommends screening for hepatitis C in pregnancy in women who are at high risk (see ‘Related ObG Topics’ below)
• New medications can result in 95–99% Hepatitis C virus (HCV) cure
• Due to opioid epidemic, incidence of HCV is rising in younger individuals
• Tasillo et al. (Obstetrics & Gynecology, 2019) sought to determine the clinical effects and cost-effectiveness of universal prenatal hepatitis C screening using computer modeling

METHODS:

• Stochastic individual-level micro-simulation model to simulate the lifetimes of 250 million pregnant women
• Women were matched at baseline with the U.S. childbearing population for
  • Age
  • Injection drug use behaviors
  • Hepatitis C virus (HCV) infection status
• Modeled outcomes included
  • Hepatitis C diagnosis | Treatment | Cure | Lifetime health care costs | Quality-adjusted life years (QALY) | Incremental cost-effectiveness ratios comparing universal prenatal hepatitis C screening to current practice
• Authors also modeled the identification of neonates exposed to maternal HCV at birth

RESULTS:

• Universal prenatal hepatitis C screening compared to current practice resulted in
  • Pregnant women with hepatitis C infection living 1.21 years longer and 16% lower HCV-attributable mortality
  • an incremental cost-effectiveness ratio of $41,000 per QALY gained
• Incremental cost-effectiveness ratios remained below $100,000 per QALY gained in most additional analyses
  • Notable exceptions included
    • Incremental cost-effectiveness ratios above $100,000 when assuming mean time to cirrhosis of 70 years
    • A cost greater than $500,000 per false positive diagnosis
    • Population HCV infection prevalence below 0.16%
  • Universal prenatal hepatitis C screening increased identification of neonates exposed to HCV at birth from 44% to 92%

CONCLUSION:

• Universal prenatal hepatitis C screening would result in
  • Improved health outcomes in women with HCV infection
  • Improved identification of at risk HCV-exposed newborns
• The authors demonstrated that universal hepatitis C screening is cost effective and further state

Universal prenatal HCV testing should be considered in plans for the elimination of viral hepatitis C as a public health threat.

Learn More – Primary Sources:

Short-Term Effects and Long-Term Cost-Effectiveness of Universal Hepatitis C Testing in Prenatal Care

What is the Effect of Hepatitis C on Fertility and Pregnancy Outcomes?

BACKGROUND AND PURPOSE:

• Hepatitis C in premenopausal women can lead to failing ovarian function
• Karampatou (Journal of Hepatology, 2017) assessed fertility and adverse pregnancy outcomes in HCV+ women

METHODS:

• 3 different cohorts were studied:
  • 100 HCV+ women with chronic liver disease (CLD), were age matched in a 2:1 proportion with 50 HBV+ women with CLD and 1:1 proportion with 100 healthy women (Italian GI unit)
  • 1,998 HCV+ women enrolled in the Italian Platform for the Study of Viral Hepatitis Therapies (PITER)
  • 6,085 HCV+; 20,415 HCV-/HIV-; 305 HCV+/HIV+ women from a large de-identified insurance database from US
• Total fertility rate (TFR) was defined as the average number of children that a woman would bear during her lifetime
• Anti-mullerian hormone (AMH) and 17β-Estradiol were used to define reproductive stage

RESULTS:

• Data from group 1
  • HCV+ and HBV+ women had similar CLD and age at first pregnancy
  • HCV+ women had higher risk of miscarriage than HBV+ (odds ratio [OR] 6.905; 95% CI 1.771-26.926)
  • HCV infection alone (OR 9.363; 95% CI 2.569-34.123, P<0.001) was significantly associated with miscarriage (multivariate analysis)
  • HCV+ women more likely to have AMH levels in the menopausal range compared to HBV+ women
  • Achieving sustained virologic response after antiviral treatment reduced the risk of miscarriage (OR 0.255; 95% CI 0.090–0.723) compared to women who failed antiviral therapy
• PITER cohort
  • Miscarriage occurred in 42.0% of women (44.6% had multiple miscarriages)
• TFR for HCV+ women between 15 and 49 years was 0.7 vs. 1.37 of Italian population of the same age range
• US cohort
  • HCV+ compared to HCV- women had a significantly higher probability of
    • Infertility (OR 2.439; 95% CI 2.130-2.794)
    • Premature birth (OR 1.34; 95% CI 1.06-1.69)
    • Gestational diabetes (OR 1.24; 95% CI 1.02-1.51)
    • Less likely to report a live birth (OR 0.754; 95% CI 0.622-0.913)

CONCLUSION:

• HPV+ women are more likely to suffer from a number of adverse pregnancy outcomes and impaired fertility and miscarriage
• These outcomes may be positively influenced by the newer generation of antiviral drugs

Learn More – Primary Sources:

Premature ovarian senescence and high miscarriage rate impair fertility in women with hepatitis C virus infection