TOP 10 - Trends in Early Testing for Perinatal Hepatitis C: Impact of 2023 CDC Guidelines in a Large Multicenter Institution

Publication Number: 2762.TOP 10

Jing Y. Khoo, Atrium Health Levine Children's Hospital, Charlotte, NC, United States; Gang Liu, Levine Children's Hospital, Charlotte, NC, United States; Christine B.. Turley, Levine Children's Hospital, Charlotte, NC, United States; Oscar G.. Gomez-Duarte, Levine Children's Hospital, Charlotte, NC, United States

Background: During the last decade, hepatitis C virus (HCV) infection rates continue to steadily rise in the reproductive-aged population in the United States, increasing the number of affected pregnancies, and, in turn, perinatal exposure. Although vertical transmission is the primary route of HCV infection in children, most infants do not receive timely testing or linkage to care. Delays in treatment can lead to long-term liver complications including fibrosis, cirrhosis, hepatocellular carcinoma, and increased mortality. Untreated HCV infection can also result in excess healthcare cost. Previous strategies deferred perinatal HCV testing until after 18 months of age, resulting in 70% of these children lost to follow-up. Consequently, in 2023, CDC guidelines recommended nucleic acid HCV testing between 2 to 6 months for perinatally exposed infants, allowing for increased identification of those infected, early referral to care, and timely treatment.

Objective: The goal of this study is to evaluate the proportion of tested and untested children perinatally exposed to HCV and understand the characteristics of these mother-baby populations. Specifically, the objectives are to (1) assess the adequacy and rates of testing for infants perinatally exposed to HCV before and after the 2023 CDC recommendations and (2) describe the social demographics of this population in relation to testing.

Design/Methods: This retrospective cohort study will assess the clinical data of mother-baby dyads related to HCV testing from multiple facilities within a single large institution. Medical records of 36,505 children born between 1 January 2022 and 10 March 2025 were evaluated, and infants were included in the cohort based on delivery within the institution, maternal residency in the surrounding area, and positive maternal HCV test results. Infants born outside of the system or with unknown or negative maternal HCV status were excluded from the analysis. Perinatal exposure was defined as positive maternal HCV antibody test prior to delivery. Measurements will include whether an HCV test evaluation occurred, type and outcome of tests ordered, and timing of HCV testing. The proportion of tested and untested infants will be quantified, and social demographics and characteristics of mothers and newborns will be compared via descriptive statistics and logistic regression analysis. The Institutional Review Board at Wake Forest University approved this study in July 2025, cohort was identified in September 2025, and analysis is expected to be completed by January 2026.