Maternal risk factors associated with inadequate testing and loss to follow-up in infants with perinatal hepatitis C virus exposure

Abstract Background Lack of adequate testing and follow-up in infants born to hepatitis C virus (HCV) infected mothers continue to be a major challenge. There are multiple risk factors associated with this low rate of testing and follow-up including maternal, healthcare-related, and social factors. We sought to identify maternal risk factors that are associated with low HCV testing and follow-up in perinatally exposed infants. Methods In a retrospective cohort study, all HCV-infected pregnant women and their infants were reviewed. The study period expanded from June 1993 to May 2016. Medical records were reviewed for maternal characteristics and risk factors that could be associated with inadequate testing and loss to follow-up in infants with perinatal HCV exposure. Results During the study period, medical records of 407 mothers and their infants were reviewed. Only 26.5% (108/407) of all infants had adequate testing and follow-up for HCV. Among all infants, history of maternal intravenous drug use (IVDU) was significantly higher in infants with inadequate HCV testing than infants who were adequately tested [88% (193/218) vs. 76% (70/92) respectively; P = 0.005]. Infants who were adequately tested for HCV had a higher percentage of mothers on methadone maintenance therapy during pregnancy than infants who were not adequately tested [53% (35/66) vs. 34% (65/186) respectively; P = 0.010]. Also, infants with mothers who had HCV care were more likely to be adequately tested than infants whose mothers did not have HCV care [54% (56/102) vs. 41% (106/255), respectively; P = 0.022]. HCV transmission rate among infants with adequate testing was 11.1% (12/108). Conclusion Infants born to HCV infected mothers continue to have suboptimal testing. Maternal history of IVDU is associated with inadequate testing and loss to follow-up among infants exposed perinatally to HCV. Whereas, maternal methadone maintenance therapy during pregnancy, and maternal HCV medical care are associated with better follow-up. Screening pregnant women with HCV infection for history of IVDU and linking them to drug treatment centers as well as to HCV medical care may improve testing and follow-up in infants with perinatal HCV exposure. Disclosures All authors: No reported disclosures.

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Hepatitis C Virus (HCV) Vertical Transmission in 12-Month-Old Infants Born to HCV-Infected Women and Assessment of Maternal Risk Factors

Open Forum Infectious Diseases ◽

10.1093/ofid/ofv089 ◽

2015 ◽

Vol 2 (2) ◽

Cited By ~ 15

Author(s):

Ravi Jhaveri ◽

Mohamed Hashem ◽

Samer S. El-Kamary ◽

Doa'a A. Saleh ◽

Sahar A. Sharaf ◽

...

Keyword(s):

Risk Factors ◽

Hepatitis C Virus ◽

Hepatitis C ◽

Pregnant Women ◽

Real Time ◽

Vertical Transmission ◽

Mode Of Delivery ◽

Hcv Rna ◽

Maternal Risk Factors ◽

Maternal Risk

Background. Hepatitis C virus (HCV) is an underappreciated cause of pediatric liver disease, most frequently acquired by vertical transmission (VT). Current guidelines that include the option of screening infants for HCV RNA at 1–2 months are based on data prior to current real-time polymerase chain reaction (PCR)-based testing. Previous studies have demonstrated VT rates of 4%–15% and an association with high maternal viral load. We evaluated HCV RNA in infants with HCV VT and assessed maternal risk factors in a prospective cohort in Cairo, Egypt. Methods. Pregnant women were screened for HCV from December 2012 to March 2014. For those with HCV viremia, their infants were tested at 12 months for HCV RNA using real-time PCR. Maternal risk factors assessed for HCV VT association included HCV RNA levels, mode of delivery, and maternal IL28B genotype. Results. Of 2514 women screened, a total of 54 women were viremic (2.1%) and delivered 56 infants. Of those, 51 infants of 49 women were tested at 12 months of age. Only 7 infants were viremic, with an HCV VT rate of 14.3% (7 of 49). Median HCV RNA in the infants was 2100 IU/mL. None of the maternal risk factors analyzed were associated with transmission. Conclusions. In Egypt where HCV is highly endemic, we observed an overall 12-month HCV VT rate of 14.3%. Further studies should focus on better identification of pregnant women more likely to vertically transmit HCV and earlier testing of infants to identify those likely to develop chronicity.

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Maternal Risk Factors Associated with Cleft Lip with or without Cleft Palate: A Review

International journal of odontostomatology ◽

10.4067/s0718-381x2016000200025 ◽

2016 ◽

Vol 10 (2) ◽

pp. 359-368 ◽

Cited By ~ 2

Author(s):

Catalina Barrera ◽

Naiara Mezarobba

Keyword(s):

Risk Factors ◽

Cleft Palate ◽

Cleft Lip ◽

Maternal Risk Factors ◽

Maternal Risk ◽

Factors Associated

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P2-445 Maternal risk factors associated with low birth weight in Wardha, India

Journal of Epidemiology & Community Health ◽

10.1136/jech.2011.142976l.75 ◽

2011 ◽

Vol 65 (Suppl 1) ◽

pp. A344-A344

Author(s):

C. Maliye ◽

M. Taywade ◽

S. Gupta ◽

P. Deshmukh ◽

B. Garg

Keyword(s):

Risk Factors ◽

Birth Weight ◽

Low Birth Weight ◽

Maternal Risk Factors ◽

Maternal Risk ◽

Factors Associated

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Maternal risk factors associated with low birth weight in Karachi: a case-control study

Eastern Mediterranean Health Journal ◽

10.26719/2007.13.6.1343 ◽

2007 ◽

Vol 13 (6) ◽

pp. 1343-1352 ◽

Cited By ~ 14

Author(s):

S.A. Rizvi ◽

J. Hatcher ◽

I. Jehan ◽

R. Qureshi

Keyword(s):

Risk Factors ◽

Birth Weight ◽

Low Birth Weight ◽

Case Control Study ◽

Case Control ◽

Maternal Risk Factors ◽

Maternal Risk ◽

Factors Associated ◽

Control Study

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Analysis of loss to follow-up in 4099 multidrug-resistant pulmonary tuberculosis patients

European Respiratory Journal ◽

10.1183/13993003.00353-2018 ◽

2019 ◽

Vol 54 (1) ◽

pp. 1800353 ◽

Cited By ~ 1

Author(s):

Ian F. Walker ◽

Oumin Shi ◽

Joseph P. Hicks ◽

Helen Elsey ◽

Xiaolin Wei ◽

...

Keyword(s):

Risk Factors ◽

Adverse Event ◽

Treatment Success ◽

Multidrug Resistant ◽

Cox Proportional Hazards Model ◽

Serious Adverse Event ◽

Loss To Follow Up ◽

Factors Associated ◽

Mdr Tb

Loss to follow-up (LFU) of ≥2 consecutive months contributes to the poor levels of treatment success in multidrug-resistant tuberculosis (MDR-TB) reported by TB programmes. We explored the timing of when LFU occurs by month of MDR-TB treatment and identified patient-level risk factors associated with LFU.We analysed a dataset of individual MDR-TB patient data (4099 patients from 22 countries). We used Kaplan–Meier survival curves to plot time to LFU and a Cox proportional hazards model to explore the association of potential risk factors with LFU.Around one-sixth (n=702) of patients were recorded as LFU. Median (interquartile range) time to LFU was 7 (3–11) months. The majority of LFU occurred in the initial phase of treatment (75% in the first 11 months). Major risk factors associated with LFU were: age 36–50 years (HR 1.3, 95% CI 1.0–1.6; p=0.04) compared with age 0–25 years, being HIV positive (HR 1.8, 95% CI 1.2–2.7; p<0.01) compared with HIV negative, on an individualised treatment regimen (HR 0.7, 95% CI 0.6–1.0; p=0.03) compared with a standardised regimen and a recorded serious adverse event (HR 0.5, 95% CI 0.4–0.6; p<0.01) compared with no serious adverse event.Both patient- and regimen-related factors were associated with LFU, which may guide interventions to improve treatment adherence, particularly in the first 11 months.

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