B.C. experts are calling for universal screening for hepatitis C in all pregnant women in Canada so that if they are infected, they can be treated with drugs after they deliver their babies and before they get pregnant again.
The hepatitis C test would be added to screening already routinely done during pregnancies for HIV and hepatitis B.
In B.C., there are about 45,000 babies born annually and based on statistical models, experts assume that there are about 450 pregnant women with hepatitis C each year. But half of women aren’t aware of their infection, so universal testing is expected to identify another few hundred women in B.C. with hepatitis C.
In a commentary in today’s Canadian Medical Association Journal, Dr. Chelsea Elwood and co-authors say there are about 3,500 pregnant women with hepatitis C each year in Canada and transmission rates from infected mothers to newborns during delivery range from five to 10 per cent.
Elwood , a gynecologist/obstetrician and reproductive infectious diseases specialist who works at B.C. Women’s Hospital and the University of B.C., said there is not yet enough evidence on safety to argue in favour of treatment during pregnancy, so prescribing medications between pregnancies is the prudent and practical approach.
A very small study recently presented at a Seattle medical conference showed that hepatitis C treatment given to women during pregnancy was effective and tolerable and did not appear to harm babies. But experts said larger studies are necessary to confirm safety and effectiveness of treatment during pregnancy.
Elwood said since hepatitis C is curable, “it behooves us to engage with women during pregnancy.”
Screening might also give doctors a chance to suggest lifestyle changes and provide better health monitoring to avoid transmission to infants in subsequent pregnancies, the B.C. authors say. Screening that identifies positive cases would also help ensure that infants born to such mothers are tested.
“Clearly, a woman who is cured before pregnancy cannot transmit (hepatitis C) to her infant,” writes Elwood and co-authors Drs. Laura Sauve and Neora Pick.
“It’s an ideal opportunity in time because they are engaged in medical care. And it means that if women get treatment between pregnancies, the transmission rate to babies will be zero,” Elwood said in an interview. She estimates that currently, there are about 20 babies who get hepatitis at the time of birth each year in B.C.
She could not cite the costs of universal testing but she is working on a cost-effectiveness analysis.
There were about 2,300 new diagnoses of hepatitis C in B.C. in 2017, according to the B.C. Centre for Disease Control. Figures for 2018 were not available, but in 2012, there were about 73,000 people living with hepatitis C in B.C. At the beginning of 2018, that number had shrunk to 33,000.
In 2017, the government provided drug funding for 2,657 people at a cost of $45,000 to over $100,000 per patient.
Hepatitis C was recognized and named as a virus causing liver damage in the late 1980s. The opioid epidemic and injection drug use has been a major factor in the rising number of infections in North America.
Naveed Zafar, a scientist at the Centre for Disease Control and UBC, said the number of those living with hepatitis C has shrunk because some people have been cured through treatment, some have died, and 25 per cent of people clear the virus without treatment. Individuals who take drugs can become reinfected if they re-engage in risky behaviours like sharing contaminated needles or having sex with infected individuals.
Zafar said it is better to treat people at an earlier stage of the disease.
“People who are cured of the virus at late stage disease have a higher risk of liver cancer and other non-liver related complications compared to those treated at an earlier stage.”
In B.C., Vancouver has the highest number of new cases (380 in 2017) but rates per population are highest in northern B.C. In northwest B.C., for example, hepatitis C rates are 91.4 for every 100,000 people compared to Richmond’s 17.3 per 100,000, the lowest rate in B.C.
Some research has shown that more than 70 per cent of those who inject drugs have hepatitis C. In a program that is unrelated to the pregnancy screening proposal, doctors at a clinic called the LAIR Centre in Vancouver will aim to detect, treat and cure patients with hepatitis C while they are receiving opiate agonist therapy like methadone .
The medical office will use a clinical trial model to simultaneously address addictions and hepatitis C “in one place at one time.”
Copyright Postmedia Network Inc., 2019