Assessing Your Patients for HCV and HIV: Why It Matters in OB/GYN Practice Today

Both human immunodeficiency virus (HIV) and hepatitis C virus (HCV) affect women, and both infections can be screened for in the women’s health setting of obstetric and gynecologic care. Once a woman with either or both of these infections is linked to care, she has a better chance of preventing transmission to others, including her unborn child.

The proportion of HIV cases in women tripled from 1985 to 2013 (7% to 24%).1 In 2017, adult and adolescent women represented 19% (7401) of the 38,739 new HIV diagnoses.2 Today, one-quarter of people living with HIV are women; 86% were infected via heterosexual transmission and 32% through injection drug use. HIV disproportionately affects black women, who represent only 15% of the female population in United States, yet 59% of cases of HIV in women.2 Only 1 in 8 HIV-positive Americans are unaware that they are infected3; 91.5% of new HIV infections were transmitted from people who were not in medical care.4

Furthermore, approximately 25% of all individuals infected with HIV are coinfected with HCV.5 Importantly, HIV increases the rate of progression of HCV-related hepatic fibrosis, and HCV is associated with a 3-fold increase in HIV antiretroviral therapy–induced liver toxicity.5

In addition to the problem of HIV, HCV infections are increasing in the United States, with an increase from 850 cases in 2010 to 2436 cases in 2015.6 The most rapid increase is among 20- to 29-year-olds who inject drugs, and many of these cases are women.6

Whereas HIV infection is now effectively manageable, chronic HCV infection is curable. Yet, despite new, highly effective direct-acting antiviral treatment regimens for HCV, their broad-scale use and associated therapeutic successes remain stymied by barriers at the patient, clinician, and healthcare system levels.7

OB/GYN clinicians are uniquely positioned to screen for these infections and, importantly, to link patients who test positive for HIV, HCV, or both, to appropriate specialist care. Linking patients to care has significant benefits, not only for the patient, but for others by minimizing transmission, including mother-to-child transmission to an unborn child.

References
1 .Centers for Disease Control and Prevention. HIV Surveillance Report. www.cdc.gov/hiv/library/reports/surveillance. Accessed March 19, 2018.
2. Centers for Disease Control and Prevention. HIV Among Women. www.cdc.gov/hiv/group/gender/women/index.html. Accessed March 20, 2019.
3. Centers for Disease Control and Prevention. HIV in the United States and Dependent Areas. www.cdc.gov/hiv/statistics/overview/ataglance.html. Accessed March 19, 2019.
4. Skarbinski J, Rosenberg E, Paz-Bailey G, et al. Human immunodeficiency virus transmission at each step of the care continuum in the United States. JAMA Intern Med. 2015;175(4):588-596.
5. Sulkowski MS, Benhamou Y. Therapeutic issues in HIV/HCV-coinfected patients. J Viral Hepat. 2007;14(6):371-386.
6. New hepatitis C infections nearly tripled over five years [press release]. Atlanta, GA: Centers for Disease Control and Prevention. May 11, 2017. https://www.cdc.gov/nchhstp/newsroom/2017/Hepatitis-Surveillance-Press-Release.html. Accessed March 19, 2019.
7. National Viral Hepatitis Roundtable. Hepatitis C: The State of Medicaid Access. October 23, 2017. https://stateofhepc.org/wp-content/uploads/2017/10/State-of-HepC_2017_FINAL.pdf. Accessed March 19, 2019.