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Andes A, Ellenberg K, Vakos A, Collins J, Fryer K. Hepatitis C Virus in Pregnancy: A Systematic Review of the Literature. Am J Perinatol 2021; 38:e1-e13. [PMID: 32323289 DOI: 10.1055/s-0040-1709672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE The aim of this study was to systematically review the literature to summarize recent demographic characteristics of hepatitis C virus (HCV) infection during pregnancy and the efficacy of risk-based versus universal screening. STUDY DESIGN PubMed, EMBASE, and Cochrane Library were searched to identify relevant studies. Studies that recognized hepatitis C as a primary or secondary outcome, with pregnant women as the population and written in English, were included. Studies were excluded if they were abstracts only, written in foreign language, or published prior to 1992. Two researchers independently screened all the studies by titles, abstracts, and full text. Conflicts were settled by a third researcher. RESULTS A total of 698 studies were identified with 78 fitting inclusion criteria. In total, 69 epidemiologic and 9 comparison studies were found. Identified risk factors for HCV infection include intravenous or illicit drug use, sexually transmitted coinfection, high-risk behaviors in the partners, high parity, and history of miscarriages or abortions. Demographic characteristics associated with HCV include non-Hispanic white race, American Indian or Alaskan Native ethnicity, and increasing age. Providers may fail to adequately screen for each risk factor, and up to two-thirds of women with a known risk factor are not screened under current guidelines. Finally, up to 27% of HCV+ women have no identifiable risk factors for infection. CONCLUSION There is evidence that risk-based screening fails to identify a large proportion of HCV positive women in pregnancy and that pregnant women with HCV risk factors and consistent with current screening guidelines fail to be tested. We urge for the adoption of universal screening to identify these women and offer treatment.
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Affiliation(s)
- Alexandra Andes
- Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Kerry Ellenberg
- Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Amanda Vakos
- Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - James Collins
- Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Kimberly Fryer
- Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, Florida
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Mostafa A, Ebeid FSE, Khaled B, Ahmed RHM, El-Sayed MH. Micro-elimination of hepatitis C through testing of Egyptian pregnant women presenting at delivery: implications for screening policies. Trop Med Int Health 2020; 25:850-860. [PMID: 32306545 DOI: 10.1111/tmi.13404] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Despite the high burden of hepatitis C virus (HCV) infection in Egypt, screening of pregnant women is not yet universal, making national and global elimination unlikely. This study assessed the proportion of pregnant women who were screened for HCV infection at delivery, the prevalence and risk factors for HCV infection, the associated adverse neonatal outcomes, and the real-life linkage to care of infected women and follow-up of their infants' HCV status and timing of testing. METHODS Data were collected from medical records of a retrospective cohort of all pregnant women who were admitted to a university hospital in Cairo for delivery between January and June 2018 (n = 6734). HCV antibody- and RNA-positive women and their infants were prospectively followed-up by phone interviews till September 2019. RESULTS 2177 (32.3%) pregnant women were screened for HCV infection. 19 (0.9%) tested HCV antibody- and RNA-positive. Being ≥ 30 years old (ORa 3.6, 95% CI: 1.4-9.2; P = 0.009), history of abortion (ORa 3.5, 95% CI: 1.2-10.3; P = 0.022) and blood transfusion (ORa 29.1, 95% CI: 9.6-88.4; P < 0.001) were independent risk factors for infection. Adverse neonatal outcomes did not vary significantly among HCV antibody-positive and antibody-negative women. Only 13 (68.4%) HCV antibody- and RNA-positive women started treatment with direct-acting antivirals (DAAs) post-breastfeeding (two completed the treatment course and were cured). Four (21.1%) did not start treatment, and two (10.5%) were lost to follow-up. All infants of the 13 HCV antibody- and RNA-positive women who started DAA therapy tested HCV RNA-negative within their first year of life. CONCLUSION Extending screening services to all pregnant women and better linkage to care are essential for the national elimination of HCV infection.
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Affiliation(s)
- Aya Mostafa
- Department of Community, Environmental, and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Fatma S E Ebeid
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt.,Clinical Research Center, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Belal Khaled
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Rania H M Ahmed
- Department of Gynecology and Obstetrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Manal H El-Sayed
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt.,Clinical Research Center, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Pyziak-Kowalska KA, Horban A, Bielecki M, Kowalska J. Missed opportunities for diagnosing viral hepatitis C in Poland. Results from routine HCV testing at the Emergency Department in the Hospital for Infectious Diseases in Warsaw. Clin Exp Hepatol 2019; 5:294-300. [PMID: 31893241 PMCID: PMC6935844 DOI: 10.5114/ceh.2019.89148] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 07/17/2019] [Indexed: 01/20/2023] Open
Abstract
AIM OF THE STUDY Current statistics indicate that approximately 150,000 (0.5%) people in Poland suffer from active hepatitis C virus (HCV) infection, but only 20% among them are aware of their status. This project is based on the concept that screening based on the presence of HCV-related risks (a patient's individual history and behavioural risk factors) is more effective than obligatory testing of the whole population. This study investigates prevalence of serological markers for HCV among patients with a risk of exposure to HCV infection. MATERIAL AND METHODS The prospective study concerning patients of 18 years and older was conducted at the Emergency Department (ED) of the Hospital for Infectious Diseases in Warsaw (from 15 September 2016 until 23 July 2018). The inclusion criteria were: a blood transfusion before 1992, more than three hospitalizations in the lifetime, suspected liver disease, elevated aminotransferase activity, imprisonment, patient's own initiative, history of injecting drug use. The rapid HCV test was performed on all patients who fulfilled inclusion criteria. The statistical analyses included calculating serological positivity rate and comparing risk-group characteristics. RESULTS Among 1502 patients consulted at the emergency department with risk factors for HCV infection during the study period, the HCV test was performed in 1487 cases. New diagnoses were confirmed in 25 cases, HCV seroprevalence was 1.68%, all patients were linked to care, 21/25 (84.0%) were HCV RNA positive. CONCLUSIONS The study confirms that routine rapid testing in certain risk groups constitutes an essential tool for identifying new HCV infections and might have an important role for public health.
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Affiliation(s)
| | - Andrzej Horban
- Hospital for Infectious Diseases, Warsaw, Poland
- Department of Adults’ Infectious Diseases, Medical University of Warsaw, Poland
| | - Maksymilian Bielecki
- Department of Psychology, SWPS University of Social Sciences and Humanities, Warsaw, Poland
| | - Justyna Kowalska
- Hospital for Infectious Diseases, Warsaw, Poland
- Department of Adults’ Infectious Diseases, Medical University of Warsaw, Poland
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Han R, Zhou J, François C, Toumi M. Prevalence of hepatitis C infection among the general population and high-risk groups in the EU/EEA: a systematic review update. BMC Infect Dis 2019; 19:655. [PMID: 31337339 PMCID: PMC6647266 DOI: 10.1186/s12879-019-4284-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 07/12/2019] [Indexed: 12/22/2022] Open
Abstract
Background Although significant improvement in efficacy measured by a sustained virological response, the high acquisition costs of direct-acting antivirals limit the access for patients and influence the costs of healthcare resource utilisation in hepatitis C. It is important to have the latest estimates of prevalence, especially in high-risk groups, for cost of illness, cost-effectiveness and budget impact studies. Methods Original studies on the estimates of the prevalence among general and high-risk groups in the European Union/European Economic Area (EU/EEA) were retrieved from Medline and Embase for the period from 2015 to 2018. All included studies were evaluated for risk of selection bias and summarised together in a narrative form. Results from previous reviews and updated searches were compared per country among different populations, respectively. Results Among the 3871 studies identified, 46 studies were included: 20 studies were used for the estimate of the general population; 3 for men who have sex with men (MSM); 6 for prisoners; and 17 for people who inject drugs (PWID). Compared with the results reported in previous systematic reviews, the updated estimates were lower than previously in most available countries. Anti-HCV general population prevalence estimates ranged from 0.54 to 1.50% by country. The highest prevalence of anti-HCV was found among PWID (range of 7.90–82.00%), followed by prisoners (7.00–41.00%), HIV-positive MSM (1.80–7.10%), HIV-negative MSM (0.20–1.80%), pregnant women (0.10–1.32%) and first-time blood donors (0.03–0.09%). Conclusions Our study highlights the heterogeneity in anti-HCV prevalence across different population groups in EU/EEA. The prevalence also varies widely between European countries. There are many countries that are not represented in our results, highlighting the need for the development of robust epidemiological studies. Electronic supplementary material The online version of this article (10.1186/s12879-019-4284-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ru Han
- University of Aix-Marseille, Marseille, France. .,Creativ-Ceutical, 215, rue de Faubourg St-Honoré, 75008, Paris, France.
| | - Junwen Zhou
- University of Aix-Marseille, Marseille, France.,Creativ-Ceutical, 215, rue de Faubourg St-Honoré, 75008, Paris, France
| | - Clément François
- University of Aix-Marseille, Marseille, France.,Creativ-Ceutical, 215, rue de Faubourg St-Honoré, 75008, Paris, France
| | - Mondher Toumi
- University of Aix-Marseille, Marseille, France.,Creativ-Ceutical, 215, rue de Faubourg St-Honoré, 75008, Paris, France
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Clifford GM, Waterboer T, Dondog B, Qiao YL, Kordzaia D, Hammouda D, Keita N, Khodakarami N, Raza SA, Sherpa AT, Zatonski W, Pawlita M, Plummer M, Franceschi S. Hepatitis C virus seroprevalence in the general female population of 9 countries in Europe, Asia and Africa. Infect Agent Cancer 2017; 12:9. [PMID: 28168002 PMCID: PMC5288860 DOI: 10.1186/s13027-017-0121-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 01/19/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND New oral treatments with very high cure rates have the potential to revolutionize global management of hepatitis C virus (HCV), but population-based data on HCV infection are missing in many low and middle-income countries (LMIC). METHODS Between 2004 and 2009, dried blood spots were collected from age-stratified female population samples of 9 countries: China, Mongolia, Poland, Guinea, Nepal, Pakistan, Algeria, Georgia and Iran. HCV antibodies were detected by a multiplex serology assay using bead-based technology. RESULTS Crude HCV prevalence ranged from 17.4% in Mongolia to 0.0% in Iran. In a pooled model adjusted by age and country, in which associations with risk factors were not statistically heterogeneous across countries, the only significant determinants of HCV positivity were age (prevalence ratio for ≥45 versus <35 years = 2.84, 95%CI 2.18-3.71) and parity (parous versus nulliparous = 1.73, 95%CI 1.02-2.93). Statistically significant increases in HCV positivity by age, but not parity, were seen in each of the three countries with the highest number of HCV infections: Mongolia, Pakistan, China. There were no associations with sexual partners nor HPV infection. HCV prevalence in women aged ≥45 years correlated well with recent estimates of female HCV-related liver cancer incidence, with the slight exception of Pakistan, which showed a higher HCV prevalence (5.2%) than expected. CONCLUSIONS HCV prevalence varies enormously in women worldwide. Medical interventions/hospitalizations linked to childbirth may have represented a route of HCV transmission, but not sexual intercourse. Combining dried blood spot collection with high-throughput HCV assays can facilitate seroepidemiological studies in LMIC where data is otherwise scarce.
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Affiliation(s)
- Gary M. Clifford
- International Agency for Research on Cancer, 150 cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Tim Waterboer
- Infection, Inflammation and Cancer Program, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Bolormaa Dondog
- Infection, Inflammation and Cancer Program, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - You Lin Qiao
- Cancer Institute of the Chinese Academy of Medical Sciences, Beijing, China
| | | | | | - Namory Keita
- Department of Obstetrics and Gynaecology, Centre Hospitalier Universitaire de Donka, Conakry, Guinea
| | - Nahid Khodakarami
- Infertility and Reproductive Health Research Centre, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Syed Ahsan Raza
- Department of Surgery, The Aga Khan University, Karachi, Pakistan
- Centre de Recherche du CHUM, Département de Médecine Sociale et Préventive Université de Montréal, Quebec, Canada
| | | | - Witold Zatonski
- The Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - Michael Pawlita
- Infection, Inflammation and Cancer Program, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Martyn Plummer
- International Agency for Research on Cancer, 150 cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Silvia Franceschi
- International Agency for Research on Cancer, 150 cours Albert Thomas, 69372 Lyon Cedex 08, France
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