Hepatitis C treatment during pregnancy: time for a practice change

Area of Science:

• Hepatology
• Obstetrics
• Infectious Diseases

Background:

• Hepatitis C virus (HCV) infection poses a significant public health challenge, particularly for individuals of reproductive age.
• Current obstetric guidelines do not recommend HCV treatment during pregnancy due to limited safety and efficacy data for direct-acting antivirals (DAAs).
• Perinatal HCV transmission risk is up to 9%, with poor infant follow-up rates after exposure.

Purpose of the Study:

• To evaluate the safety and efficacy of DAAs for treating HCV infection during pregnancy.
• To highlight pregnancy as an optimal window for HCV treatment due to continuous patient engagement in care.
• To inform obstetrician-gynecologists about shared decision-making regarding HCV treatment in pregnant individuals.

Main Methods:

• Review of recent evidence on DAA use in pregnancy.
• Analysis of cure rates in pregnant versus non-pregnant adults.
• Assessment of data on DAA exposure during the second and third trimesters and through breastmilk.

Main Results:

• Growing evidence indicates DAAs are safe and effective for HCV treatment during pregnancy, with cure rates comparable to non-pregnant adults.
• Limited but reassuring data exists regarding DAA exposure through breastmilk.
• Ledipasvir/sofosbuvir and sofosbuvir/velpatasvir have the most available data for pregnancy treatment.

Conclusions:

• HCV treatment during pregnancy is feasible and recommended, ideally initiated in the second or third trimesters.
• Shared decision-making is crucial, balancing treatment benefits against DAA exposure data.
• Multidisciplinary collaboration is essential for optimizing HCV treatment access in pregnant individuals.