1 Departments of Surgery, Medicine, and Nursing, University of California at Los Angeles, Los Angeles, California, Gilead Sciences, Foster City, and the Los Angeles County Department of Public Health, Los Angeles, California.
Hepatitis C virus (HCV) infection affects 170 million people worldwide, with at least 5% of individuals with HCV progressing to life-threatening complications, including hepatocellular carcinoma, within 20 years from acute infection. The World Health Organization has called for viral hepatitis elimination as a major public health threat by 2030. The recent development and availability of direct-acting antiviral drugs have been a game-changer in the HCV-treatment paradigm-response exceeds 90%, with minimal adverse events. Accordingly, the U.S. Preventive Services Task Force and the American Association for the Study of Liver Disease-Infectious Diseases Society of America 2019 guidelines recommend universal HCV screening for all adults aged 18-79 years, including pregnant women. Worldwide, up to 8% of pregnant women have HCV infection, with the prevalence being as high as 4% in the United States. Pregnancy is one of the few points of contact women of reproductive age have with their health care providers; therefore, pregnancy provides a crucial time for targeting this population for HCV screening. Children also benefit from maternal screening, because the primary route of infection in children is vertical transmission during pregnancy, and children are not routinely assessed for liver disease. In fact, 85-95% of children with HCV infection in the United States are not yet identified with current strategies. In this commentary, we highlight why universal screening in pregnant women should be recommended by the American College of Obstetricians and Gynecologists based on the current epidemiology of HCV and the upcoming U.S. Preventive Services Task Force-recommended screening changes for all adults aged 18-79 years. We also review the current screening paradigm and treatment options for pregnant women and their children.