Evaluating Women’s Preferences for Hepatitis C Treatment During Pregnancy

Abstract

There is a rising prevalence of hepatitis C (HCV) among women of child‐bearing age nationally, which prompted a recommendation by national guidelines to screen all women for HCV during pregnancy. Women with HCV during pregnancy are at risk of perinatal transmission of HCV. Directly acting antiviral (DAA) therapy during pregnancy can potentially reduce the risk of perinatal transmission as well as cure women while they are engaged in antenatal care. However, data on the safety and efficacy of DAAs during pregnancy are limited. We aimed to evaluate the preferences of women with HCV regarding potential DAA treatment during pregnancy. We conducted a survey of women with a history of HCV followed in the University of California, San Francisco HCV clinic and in the Women’s Interagency HIV Study (most of whom are coinfected with HIV) to determine their preferences for DAA treatment during pregnancy. A total of 141 women completed the survey. Sixty percent reported that they would be willing to take antepartum DAA therapy if it lowered the risk of perinatal transmission. Only 21% reported that they would agree to take DAA therapy during pregnancy for self‐cure; 20% of women stated that they would not, yet indicated that they might change their minds if there were more human data available regarding use of DAAs during pregnancy. In multivariable analysis, having a previous history of taking DAAs and being of childbearing age at the time of the survey were associated with willingness to take DAA medication during pregnancy (odds ratios 4.29 and 4.11, respectively). Conclusion: These results point to the need for further investigation of the role of HCV therapy during pregnancy.

Cost-effectiveness of Universal Hepatitis C Virus Screening of Pregnant Women in the United States

“…For example, among a recent study, only 21% of HCV-infected women reported willingness to take DAAs during pregnancy for their individual benefit, but 60% reported willingness if it reduces perinatal transmission. (46) Third, our cost-effectiveness evaluation incorporates health benefits among pregnant women only, as the outcome of HCV diagnosis during pregnancy on subsequent testing among children is uncertain and pediatric management of HCV is changing (with studies evaluating treatment among children as young as 2). As such, for the cost-effectiveness analysis we neglect additional benefits related to HCV diagnosis and management among babies born to women identified with HCV, although we estimate screening could identify ~300 children born with HCV as a result of pregnancies in 2018.…”

Review article: direct‐acting antivirals for the treatment of HCV during pregnancy and lactation ‐ implications for maternal dosing, foetal exposure, and safety for mother and child

“…However, pregnant women may experience psychological stress as treatment start has to be postponed to the postpartum period. A recent survey showed that among women with (a history of) HCV, 60% were willing to undergo HCV therapy during pregnancy given the fact that it would reduce the risk of vertical transmission, and despite the lack of safety data …”

HCV in Women and Pregnancy

“…(59) Given the increasing burden of disease in this population, there is increasing interest in treatment in pregnancy, with the simultaneous goals of interrupting vertical transmission and achieving cure with a majority of HCV-positive women interested in treatment during pregnancy, to prevent mother-to-child transmission. (60) Prospective data on DAA therapy in pregnancy is limited to a single study (n = 7) evaluating a 12-week course of sofosbuvir/ledipasvir in genotype 1 infection. All achieved SVR12 and delivered at term without serious (grade 3 or 4) adverse events in mothers or infants; pharmacokinetic analysis and long-term pediatric follow-up is ongoing.…”