CDC recommends earlier HCV testing for perinatally exposed infants and children

The Centers for Disease Control and Prevention (CDC) has released new recommendations on hepatitis C virus (HCV) testing for perinatally exposed infants and children. The new recommendations were published in Morbidity and Mortality Weekly Report (MMWR).

These updated recommendations were developed using data captured from a systematic review and meta-analysis and serve as a supplement to universal HCV screening recommendations for adults that were released by the CDC in 2020.

In the analysis, researchers assessed HCV screening requirements in infants and children who were perinatally exposed to pregnant persons with current or probable HCV infection. Data for the analysis were published from January 2001 through June 2021 and sourced from 5 databases. Studies on perinatal HCV testing, HCV in pregnancy, and the harms of perinatal HCV testing were screened for inclusion in the review.

In studies conducted among children who were perinatally exposed to HCV infection, 16.7% (range, 1.9%-31.4%) were referred for HCV testing. Moreover, data captured from 12 studies showed that 30.1% (range, 8.6%-53.1%) of perinatally exposed infants and children were assessed for HCV RNA via anti-HCV or nucleic acid testing (NAT).

Potential harms associated with HCV testing included intermittent or transient viremia, false-positive or false-negative antibody results, and the cost of testing.

To increase the identification of HCV infection in perinatally exposed infants and children, the CDC introduced several new recommendations:

• Assess HCV RNA via NAT at 2 to 6 months of age to identify those at risk for chronic HCV infection;
• Assess HCV RNA via NAT for those aged 7 to 17 months who have not been tested;
• Assess HCV RNA via anti-HCV testing followed by reflex NAT (if anti-HCV is reactive) for those aged 18 months and older who have not been tested; and
• Consult with a health care provider with expertise in pediatric HCV management for those with detectable HCV RNA.

Infants and children with undetectable HCV RNA are not recommended for further monitoring unless clinically warranted.

Several limitations were noted for the data used to support these new recommendations. These include heterogeneity, potentially outdated HCV testing methods and definitions of HCV infection, the exclusion of international studies, and concerns with the quality of evidence for individual studies, among others.

“Testing perinatally exposed infants beginning at age 2 months with a NAT for HCV RNA is cost-effective and allows for earlier linkage to care, appropriate evaluation, and the opportunity to provide curative, life-saving therapy,” the researchers noted. “The identification of and linkage to curative treatment for all persons with HCV infection (including infants and children) is essential to ensuring that no population is left behind in the pursuit of national hepatitis C elimination goals,” they concluded.

By Peter Tran

References:

Panagiotakopoulos L, Sandul AL, Conners EE, Foster MA, Nelson NP, Wester C. CDC recommendations for hepatitis C testing among perinatally exposed infants and children — United States, 2023. MMWR Morb Mortal Wkly Rep. 2023;72(4);1-19. doi:10.15585/mmwr.rr7204a1