EPIDEMIOLOGIC PREDICTORS OF HEPATITIS-C VIRUS-INFECTION IN PREGNANT-WOMEN

Objective: To identify sensitive epidemiologic predictors of a positiv e hepatitis C virus antibody test in asymptomatic persons, and to comp are the cost of testing only persons with an epidemiologic predictor t o that of universal screening. Methods: Seventeen hundred consecutive pregnant women were tested by enzyme-linked immunosorbent assay for an tibody to hepatitis C virus. Seventy-five subjects tested positive and were compared with 257 pregnant women who tested negative. Cohort and control patients were interviewed and their medical records were revi ewed to identify those with chosen predictors of a positive hepatitis C virus antibody test. Results: Seventy-four of 75 cohort patients and 108 of 257 controls had one or more predictors of a positive antibody test. Cohort patients were significantly more likely (P < .001) to ha ve the following: human immunodeficiency virus infection, a sex partne r with a risk factor for hepatitis, age greater than 30 years, and a h istory of drug use, blood transfusion, sexually transmitted disease, h epatitis, or incarceration. The sensitivity and specificity of a singl e predictor in identifying a person with a positive test were 99 and 5 8%, respectively. The cost of finding a single individual with a posit ive antibody test by universal screening was $674, compared to $303 by selectively screening persons with one or more predictors of a positi ve antibody test. Conclusions: Most individuals with positive hepatiti s C virus antibody tests can be identified on the basis of epidemiolog ic predictors, reducing the cost of testing by 55%. These patients may receive appropriate medical therapy, and their children may be evalua ted for possible infection by vertical transmission of hepatitis C vir us.