Hepatitis C in Pregnancy: A Unique Opportunity to Improve the Hepatitis C Cascade of Care

Kushner, Tatyana; Terrault, Norah A.

doi:10.1002/hep4.1282

Cited by 43 publications

(43 citation statements)

References 71 publications

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“…We posit that perinatal care may provide a potential opportunity for HCV testing in women of reproductive age and for linking infected young women to HCV‐related care . Indeed, we observed that among women with a history of pregnancy, 60.5% had received HCV testing at some point in time, and of the 10 women with HCV viremia, 60% were linked to treatment—a higher rate than that observed in the overall cohort.…”

Section: Discussionmentioning

confidence: 85%

Hepatitis C Screening in an Underserved U.S. Cohort of Reproductive Age Women

et al. 2019

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The opioid epidemic has recently increased the rates of hepatitis C virus (HCV) infection among young women. We therefore aimed to characterize the cascade of HCV care in a cohort of underserved women of reproductive age. Medical records of 19,121 women between the ages of 15 and 44 years, receiving primary care in the San Francisco safety‐net health care system, were reviewed. Cohort characteristics were as follows: median age 33 years (interquartile range 26‐38), 18% white (12% black, 46% Latina, 22% Asian, 2% other race), 1.3% hepatitis B surface antigen (HBsAg)‐positive, and 0.9% human immunodeficiency virus (HIV) co‐infection. HCV antibody (HCVAb) testing occurred in 38.7% (n = 7,406), of whom 2.8% (n = 206) were HCVAb‐positive and 2.4% (n = 177) had a detectable HCV viral load. Of the 5% (n = 1,017) with a history of pregnancy, 61% (n = 615) had HCVAb testing (2.6% were positive). On multivariable analysis, HBsAg testing (odds ratio [OR] 8.25 [95% confidence interval (CI)] 6.80‐10.01]; P < 0.001), HIV infection (OR 5.98 [95% CI 1.86‐19.20]; P = 0.003), and log alanine aminotransferase (ALT) (OR 1.30 [95% CI 1.16‐1.45]; P < 0.001) were associated with HCV screening. Compared with whites, women of Latina (OR 0.45 [95% CI 0.37‐0.55]; P < 0.001) and Asian (OR 0.74 [95% CI 0.58‐0.94]; P = 0.01) race were less likely to receive HCV screening. Age (OR 1.80 per decade [95% CI 1.26‐2.57]; P = 0.001), white race (versus non‐white; OR 10.48 [95% CI 7.22‐15.21]; P < 0.001), HIV infection (OR 3.25 [95% CI 1.40‐7.55]; P = 0.006), and log ALT (OR 1.93 [95% CI 1.49‐2.49]; P < 0.001) were associated with HCVAb positivity. Conclusion: Most (>60%) underserved women of reproductive age were not tested for HCV. Moreover, women of Latina and Asian race were less likely to receive HCV screening. Given the known high HCV risk in the underserved population, targeted interventions, especially for racial minority women of reproductive age, are needed to enhance HCV screening in those at risk.

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Section: Discussionmentioning

confidence: 85%

Hepatitis C Screening in an Underserved U.S. Cohort of Reproductive Age Women

et al. 2019

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“…There are multiple reasons to either consider or defer DAA treatment during pregnancy as reviewed extensively by others . Although the AASLD/IDSA guidelines recommend universal screening of pregnant women, no DAA regimen is currently approved for treatment during pregnancy because of insufficient human safety and efficacy data and treatment is therefore delayed until after delivery.…”

Section: Discussionmentioning

confidence: 99%

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

Freriksen

Seyen²,

Judd

et al. 2019

Aliment Pharmacol Ther

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Summary Background With the global efforts to eradicate hepatitis C virus (HCV), treatment during pregnancy is becoming a priority for research as this, and maternal cure should reduce vertical transmission. However, as information on the efficacy and safety of direct‐acting antivirals (DAAs) in pregnancy is generally lacking, treatment of HCV infection during pregnancy is not currently recommended. Aim To provide an overview of current knowledge regarding maternal exposure, placental handling and safety of DAAs during pregnancy and lactation Methods A literature search was performed focusing on the effect of pregnancy on maternal exposure to DAAs, the placental handling of DAAs, the safety of DAAs for mother and child during pregnancy and the safety of DAAs during lactation. Results Exposure to all DAAs studied is likely to be altered during pregnancy, mostly related to pregnancy‐induced effects on drug absorption and metabolism. Although animal studies show that most DAAs are reported to cross the placenta and transfer into breast milk, most DAA combinations show a favourable safety profile. Because of the rapid viral decline after treatment initiation, and to avoid the critical period of organogenesis, treatment may be started at the end of the second trimester or early third trimester. Conclusions Treatment of HCV infection during pregnancy is realistic, as DAAs are highly effective and treatment duration is relatively short. There is an urgent need to study DAAs during pregnancy and lactation to contribute to the goal of HCV elimination.

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“…Nevertheless, alone being an infant to Hepatitis C virus infected mother put them in the greater danger zone. 1,37 In this study, as much as (48.2%) of neonates born to these mothers, had lower than normal birth weight. On the similar note (41.2%) neonates failed to reach the term and were born before term.…”

Section: Discussionmentioning

confidence: 44%

“…6 This enhances the risk for vertical transmission of the infection to the next generation. 1,20 Benova L et al, determine this risk round the world as of approximately 5.8%. 24 Among children with hepatitis C infection, 0.2% -0.4% in European countries and United States while 12 -14% in Africa have acquired the infection via their mother's womb.…”

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confidence: 99%

Hepatitis C in pregnancy: an observational study highlighting its association with maternal parameters

Bushra¹,

Ghori²,

Ahmed³

et al. 2019

Int J Res Med Sci

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Background: Pregnancy is a very crucial time in a woman’s life. In this period of time, not only multiple physiological alterations effect the usual health status but also makes women more vulnerable to contract infection and face negative sequalae. Hepatitis C, a blood borne viral infection serve the similar fate when encountered by pregnant ladies. This study is based on exploring the prevalence of the Hepatitis C virus seropositivity among pregnant population. Moreover, we also evaluated the major risk factors leading to the infection in these mothers. Besides this, infected mothers were studied for their pregnancy outcomes.Methods: In this study 114 pregnant females were observed for this cross-sectional study. It was conducted in Gynecology Unit- 1, Liaquat University Hospital Hyderabad, for the period of January 2017 to July 2017. Chi square test was applied for statistical analysis on SPSS version 16. The criteria for enrollment in the study was set to be a pregnant lady belonging to age group 20-35 years; having singleton pregnancy; was a booked case at the hospital with compliant to antenatal follow ups; admitted to the labor room for delivery. All the non-pregnant ladies, whom had co morbid conditions such as hypertension or diabetes or had infected with hepatitis B or D were excluded from the study. Furthermore, pregnant ladies with multiple gestion or those who were either diagnosed of hepatitis C prior to conceive or had a previous history of hepatitis C were also excluded.Results: Present study revealed that out of 114, 10(8.8%) pregnant ladies were found seropositive for Hepatitis C virus. Prior history for transfusion of blood was the Foremost risk factor discovered, with 60.5% women reported this. History of surgery was the 2nd commonest factor and 43.9% had this in their medical records. On the other hand, only 8.8% women gave the history for previous evacuation. While observing pregnancy outcomes, we found 48.2% neonates had low birth weight, 41.2% were born preterm and 21.1% had low APGAR score.Conclusions: In a nutshell hepatitis c is prevalent in the pregnant population of this region and showing its effects in the form of compromised pregnancies. History of blood transfusion and previous surgery were found to be chief risk factors in the study.

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Hepatitis C in Pregnancy: A Unique Opportunity to Improve the Hepatitis C Cascade of Care

Cited by 43 publications

References 71 publications

Hepatitis C Screening in an Underserved U.S. Cohort of Reproductive Age Women

Hepatitis C Screening in an Underserved U.S. Cohort of Reproductive Age Women

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

Hepatitis C in pregnancy: an observational study highlighting its association with maternal parameters

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