Hepatitis C screening of mothers using methadone and their babies is inadequate

Dr Ralph Nanan, Professor of Paediatrics at the University of Sydney, and his co-authors undertook a retrospective review of medical records from two major hospitals in Sydney and a hospital in rural NSW.

Of 295 pregnant women on methadone maintenance treatment, 288 (98 per cent) were tested for anti-HCV antibodies, compared with 1955 (20 per cent) of 9987 women who were not on methadone treatment.

Seropositive (presence of antibodies) results were obtained for 243 women in the methadone group (84 per cent) and 54 in the non-methadone group (three per cent).

Data were not available on all of the infants of HCV-seropositive methadone maintained mothers.  But of the infants of HCV-seropositive methadone-maintained mothers for whom data were available, only 27 per cent received follow-up HCV screening during the 18 months after birth.

One of the infants tested positive for anti-HCV antibodies and HCV RNA, meaning that the infant was viraemic (ie, HCV virus was present in their blood).

“Our study indicates that screening for HCV infection in the high-risk population of pregnant women on methadone maintenance and their infants is inadequate,” Professor Nanan said.

“This is a serious concern because HCV is a major cause of chronic liver disease, including cirrhosis and liver cancer.”

Professor Nanan said a number of measures should be considered to ensure pregnant women and their infants received appropriate screening for HCV, including:

• Compliance with the Royal Australian and New Zealand College of Obstetricians and Gynaecologists’ recommendation that all pregnant women be screened for HCV infection
• Infants of HCV RNA-positive mothers to be tested for HCV RNA at six weeks and six months of age and for anti-HCV antibodies at 18 months of age and
• The introduction of a national HCV registry, similar to the National HIV Database, which would help track children with HCV infection, in order to elucidate its true incidence and natural history.

The Medical Journal of Australia is a publication of the Australian Medical Association.

^{The statements or opinions that are expressed in the MJA reflect the views of the authors and do not represent the official policy of the AMA unless that is so stated.}

CONTACT:

Dr Ralph Nanan                              0414 835 505

Mr Jacob O’Shaughnessy                  0421 617 861
Media Officer University of Sydney