Pregnancy Care: Value of Adopting Revised Hepatitis C Guidelines

Although the consensus on approaches for developing evidence-based guidelines in the medical community is growing, less attention has gone toward assessing the applicability of current guidelines.

However, recent research discovered by Quest Diagnostics in collaboration with the CDC highlights the importance of implementing revised hepatitis C virus (HCV) infection diagnosis and treatment guidelines for pregnant individuals.

“For roughly ten years, Quest Diagnostics has been working with the Division of Viral Hepatitis at the Centers for Disease Control, with the goal of providing study insights associated with hepatitis,” explained Harvey W. Kaufman, MD, senior medical director at Quest Diagnostics and head of Quest Diagnostics Health Trends research.

The findings from this nationally representative study published in Obstetrics & Gynecology show that the rate of HCV antibody screening increased by 145% in pregnant people during the decade-long study period ending 2021 though the rate of screening remains low, with only 41% of pregnant people receiving screening in early 2021.

Kaufman notes that this study adds to a body of previous literature, including a 2018 study demonstrating that the testing rate of pregnant people and newborns has been increasing as well as the positivity rate for hepatitis C, partly due to the opioid endemic.

The Obstetrics & Gynecology study including more than 5 million pregnant people indicates that those using Medicaid are less likely to be screened for hepatitis C than those using commercial insurance, indicating disparities in prenatal healthcare.

As the most common bloodborne infection in the United States and the leading cause of liver-related morbidity and mortality, hepatitis C is estimated to affect around 2.4 million adults in the US. In 2018 alone, hepatitis C was reported as the underlying or contributing cause for 15,713 deaths. What’s more, an estimated 70% of adults with acute HCV infection develop chronic disease.

In pregnant people, the risk of an HCV-infected parent transmitting the infection to their infant is approximately 4–7% per pregnancy, resulting in around 1,700 HCV-infected infants born each year from 2011 to 2014.

If left untreated, around 25% of these people will die prematurely from HCV-associated complications, including liver failure and hepatocellular carcinoma. Even more alarming is that, between 2015 and 2018, only 61% of people diagnosed with hepatitis C were aware they were living with the disease, signifying a significant gap in care.

“The study examines the impact of the revised guidelines and shows that the inclusion of hepatitis C testing had been increasing for quite a number of years prior to that, but accelerated when the guidelines were issued,” Kaufman said.

In March 2020, the US Preventive Services Task Force (USPSTF) issued guidelines encouraging clinicians to screen all patients aged 18–79 for hepatitis C virus (HCV) infection. The USPSTF also suggests that physicians consider screening high-risk patients for HCV younger than 18 years and older than 79.

In April 2020, the CDC updated its guidelines by recommending HCV screening for adults aged 18 years and over and all pregnant people during each pregnancy. The American College of Obstetricians and Gynecologists eventually followed these agencies and updated its guidelines in May 2021.

“It is important for physicians to acknowledge these new guidelines and change their medical practices in response,” said Kaufman. “It always takes time to integrate new information, and the doctors are no different in terms of adopting new information and integrating that into their practices,” he continued.

Although the responsibility of closing this gap falls upon healthcare providers and government organizations like the CDC, Kaufman explained that doctors must adopt a more vigilant approach by ordering the appropriate testing at the right time for their patients.

“There's still a lot of room for improvement,” he noted. “There are opportunities to improve awareness and communication, using agencies like the CDC, US Preventative Services Task Force, or American College of Obstetricians and Gynecologists.”

While these organizations all tend to rely on publications for guidelines, medical providers and the laboratory community have an important duty to review and implement new authoritative recommendations to help patients access the care they need.

Unfortunately, the healthcare system does not work the same for all, leaving those without commercial insurance particularly vulnerable to health issues and missed diagnoses. Rising healthcare costs and access to medicine are other notable medical obstacles in the US.

In the mid-2010s, various obstacles existed regarding coverage for hepatitis C treatment, specifically for the Medicaid population, because the drugs required for treatment are not only highly effective but also extremely expensive.

“In recent years, these various price restrictions on hepatitis C treatments have been lifted, which may help close the gap between commercial-insured patients and Medicaid-insured patients,” Kaufman clarifies.

Kaufman notes that “because no system is perfect, there are always opportunities for improvement” and adds that maintaining a healthy relationship between the laboratory community and healthcare providers is also vital to improving the health of individuals in the US.

“Now, the laboratory community is also starting to spread the word about these new guidelines and encourage doctors to get on board,” said Kaufman, stressing that all healthcare workers are responsible for being familiar with the most up-to-date guidelines in order to provide the most effective natal care.

“In essence, the guidelines do matter,” concluded Kaufman.