A study presented at The Liver Meeting highlighted significant gaps in hepatitis C virus (HCV) testing and treatment among pregnant individuals in Canada. Conducted by Andrew B. Mendlowitz, PhD, MBiotech, and colleagues, the population-based, retrospective cohort study analyzed pregnancies in Ontario from 2008 to 2020, linked to HCV testing records from 1999 to 2020.
Key findings include:
- Nearly 23% of individuals positive for HCV antibodies had their earliest RNA test during pregnancy.
- Among nearly 5,000 individuals with a positive RNA test, less than 50% initiated treatment.
- Over half of the cohort did not receive RNA testing after a positive antibody result, and over half did not initiate treatment after confirmation of viremia.
- Subsequent pregnancies often occurred after an HCV diagnosis with no evidence of treatment, posing a risk for transmission to infants.
- The study identified 28,761 pregnancies among 13,432 individuals positive for HCV antibodies and/or with records of HCV RNA testing. The time to RNA test from a positive antibody test improved significantly from 47.5 weeks before 2012 to 5.7 weeks after 2018. Similarly, the time to treatment from an RNA-positive test improved from 15.1 years to 1.9 years during the same period.
However, 20.1% of individuals with a positive antibody test had at least one pregnancy before receiving a subsequent RNA test. Of those with an RNA-positive record, a minority received treatment. An estimated 195 infants may have been infected due to missed opportunities for engagement.
The study underscores the need for improved HCV care for pregnant people, including universal screening in each pregnancy and exploration of treatment in late pregnancy, to minimize the risk of HCV transmission to newborns.