MJA
MJA

Screening for hepatitis C virus infection in methadone-maintained mothers and their infants

Med J Aust 2009; 191 (10): 535-538.

Summary

Objective: To describe the patterns of screening for hepatitis C virus (HCV) infection in methadone-maintained pregnant women and their infants.

Design, setting and patients: Retrospective review of medical records from one rural and two metropolitan hospitals in New South Wales for pregnant women on methadone maintenance treatment and infants born to these women between 1 January 2000 and 31 December 2006, as well as records for pregnant women who were not on methadone treatment.

Main outcome measures: Rates of anti-HCV antibody and HCV RNA testing for pregnant women and their infants, and ages at which infants attended follow-up appointments.

Results: Of 295 pregnant women on methadone maintenance treatment, 288 were tested for anti-HCV antibodies (98%), compared with 1995 of 9987 women who were not on methadone treatment (20%) (P < 0.001). Seropositive results were obtained for 243 women in the methadone group (84%) and 54 in the non-methadone group (3%) (P < 0.001), of whom 44 (18%) and 17 (31%), respectively, were subsequently tested for HCV RNA (P = 0.03). HCV RNA test results were positive for 31 (70%) and 10 (59%) seropositive women in the methadone and non-methadone groups, respectively (P = 0.39). Of infants of HCV-seropositive methadone-maintained mothers, 27% of those for whom we had follow-up attendance data received HCV screening, and one of these infants tested positive for anti-HCV antibodies and HCV RNA.

Conclusions: Screening for HCV infection in the high-risk population of pregnant women on methadone maintenance treatment and their infants is inadequate. This could lead to significant underdetection of active HCV infection in this high-risk population, and their infants. Current screening guidelines may therefore need to be revised.

  • Anthony J W Liu,*1
  • Ethan I An,* 1
  • Henry G Murray2
  • Emma Tetstall1
  • Marcel J Leroi3
  • Ralph K H Nanan1

  • 1 Discipline of Paediatrics, Sydney Medical School — Nepean, University of Sydney, Sydney, NSW.
  • 2 Department of Obstetrics and Gynaecology, Nepean Hospital, Sydney West Area Health Service, Sydney, NSW.
  • 3 Department of Pathology, Nepean Hospital, Sydney West Area Health Service, Sydney, NSW.

Correspondence: liua@wahs.nsw.gov.au

Acknowledgements: 

We thank Beth Bendall and Barbara Crowhurst for assistance with the data extraction.

Competing interests:

None identified.

  • 1. Global surveillance and control of hepatitis C. Report of a WHO Consultation organized in collaboration with the Viral Hepatitis Prevention Board, Antwerp, Belgium. J Viral Hepat 1999; 6: 35-47.
  • 2. Razali K, Thein HH, Bell J, et al. Modelling the hepatitis C virus epidemic in Australia. Drug Alcohol Depend 2007; 91: 228-235.
  • 3. Hallinan R, Byrne A, Amin J, Dore GJ. Hepatitis C virus prevalence and outcomes among injecting drug users on opioid replacement therapy. J Gastroenterol Hepatol 2005; 20: 1082-1086.
  • 4. MacDonald MA, Wodak AD, Dolan KA, et al. Hepatitis C virus antibody prevalence among injecting drug users at selected needle and syringe programs in Australia, 1995–1997. Med J Aust 2000; 172: 57-61. <MJA full text>
  • 5. Selvey LA, Denton M, Plant AJ. Incidence and prevalence of hepatitis C among clients of a Brisbane methadone clinic: factors influencing hepatitis C serostatus. Aust N Z J Public Health 1997; 21: 102-104.
  • 6. Lauer GM, Walker BD. Hepatitis C virus infection. N Engl J Med 2001; 345: 41-52.
  • 7. Birnbaum AH, Shneider BL, Moy L. Hepatitis C in children. N Engl J Med 2000; 342: 290-291.
  • 8. Spencer JD, Latt N, Beeby PJ, et al. Transmission of hepatitis C virus to infants of human immunodeficiency virus-negative intravenous drug-using mothers: rate of infection and assessment of risk factors for transmission. J Viral Hepat 1997; 4: 395-409.
  • 9. Resti M, Azzari C, Mannelli F, et al. Mother to child transmission of hepatitis C virus: prospective study of risk factors and timing of infection in children born to women seronagative for HIV-1. BMJ 1998; 317: 437-441.
  • 10. Ohto H, Terazawa S, Sasaki N, et al. Transmission of hepatitis C virus from mothers to infants. N Engl J Med 1994; 330: 744-750.
  • 11. Alter MJ, Margolis HS, Krawczynski K, et al. The natural history of community-acquired hepatitis C in the United States. The Sentinel Counties Chronic non-A, non-B Hepatitis Study Team. N Engl J Med 1992; 327: 1899-1905.
  • 12. Shakil AO, Conry-Cantilena C, Alter HJ, et al. Volunteer blood donors with antibody to hepatitis C virus: clinical, biochemical, virologic, and histologic features. The Hepatitis C Study Group. Ann Intern Med 1995; 123: 330-337.
  • 13. NSW Department of Health. National clinical guidelines for the management of drug use during pregnancy, birth and the early development years of the newborn. Canberra: Commonwealth of Australia, 2006. http://www.health.nsw.gov.au/pubs/2006/pdf/ncg_druguse.pdf (accessed Jan 2009).
  • 14. Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Hepatitis C. College statement 2007. http://www.ranzcog. edu.au/publications/statements/C-gen4.pdf (accessed Jan 2009).
  • 15. Australian Bureau of Statistics. Census of Population and Housing: Socio-Economic Indexes for Areas (SEIFA), Australia — data only, 2006. Canberra: ABS, 2006. (ABS Cat. No. 2033.0.55.001.) http://www.abs.gov.au/AUSSTATS/ abs@.nsf/allprimarymainfeatures/A1C03322C1AD9CF0CA2575DA00156075?opendocument#6 (accessed Oct 2009).
  • 16. Australian Bureau of Statistics. National Regional Profile: Blacktown (C) (Local Government Area). Canberra: ABS, 2006. http://www.abs.gov.au/AUSSTATS/abs@.nsf/Latestproducts/LGA10750Population/People12002-2006?opendocument&tabname=Summary&prodno=LGA10750&issue=2002-2006 (accessed Mar 2009).
  • 17. Australian Bureau of Statistics. National Regional Profile: Penrith (C) (Local Government Area). Canberra: ABS, 2006. http://www.abs. gov.au/AUSSTATS/abs@.nsf/Latestproducts/LGA16350Population/People12002-2006 ?opendocument&tabname=Summary& prodno=LGA16350&issue=2002-2006 (accessed Mar 2009).
  • 18. Australian Bureau of Statistics. National Regional Profile: New South Wales. Canberra: ABS, 2006. http://www.abs.gov.au/AUSSTATS/abs@.nsf/Latestproducts/LGA1Population/People12002-2006?opendocument&tabname=Summary&prodno=LGA1&issue=2002-2006 (accessed Mar 2009).
  • 19. Hardikar W, Elliott EJ, Jones CA. The silent infection: should we be testing for perinatal hepatitis C and, if so, how [editorial]? Med J Aust 2006; 184: 54-55. <MJA full text>
  • 20. Alter MI, Kruszon-Moran D, Nainan OV, et al. The prevalence of hepatitis C virus infection in the United States, 1988 through 1994. N Engl J Med 1999; 341: 556-562.
  • 21. Conry-Cantilena C, Van Raden M, Gibble J, et al. Routes of infection, viremia, and liver disease in blood donors found to have hepatitis C virus infection. N Engl J Med 1996; 334: 1691-1696.
  • 22. Spencer JD, Tibbits D, Tippet C, et al. Review of antenatal testing policies and practice for HIV and hepatitis C infection. Aust N Z J Public Health 2003; 27: 614-619.
  • 23. Tetstall E, Liu AJW, An E, et al. Pregnancy and neonatal characteristics of opioid-dependent Indigenous Australians: a rural and metropolitan comparison. Aust N Z J Obstet Gynaecol 2009; 49: 279-284.
  • 24. Kaldor J, Jones CA, Elliott E, et al. Hepatitis C virus infection. In: Elliott EJ, Cronin P, Rose D, Zurynski Y, editors. Australian Paediatric Surveillance Unit surveillance report, 2002–2003. Sydney: APSU, 2005: 37-38.
  • 25. National HIV/AIDS Strategy: revitalising Australia’s response 2005–2008. Canberra: Commonwealth of Australia, 2005.

Author

remove_circle_outline Delete Author
add_circle_outline Add Author

Comment
Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article