Treatment of Women With Hepatitis C Diagnosed in Pregnancy: a Co-Located Treatment Approach

Kushner, Tatyana; Lange, Marcia; Sperling, Rhoda; Dieterich, Douglas T.

doi:10.1053/j.gastro.2022.07.017

Cited by 15 publications

(13 citation statements)

References 5 publications

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“…Data are desperately needed regarding exposures of DAAs during pregnancy. To date, there is a small pharmacokinetic study of ledipasvir/sofosbuvir and several other case series describing DAA treatment in pregnancy [ 60 ••, 63 – 65 ]. To add to these data, the Coalition for Global Hepatitis Elimination launched the Treatment In Pregnancy for Hepatitis C (The TiP-HepC) Registry to collect clinical information with the goal of prospectively informing decision-making for treatment of HCV during pregnancy [ 66 ].…”

Section: Next Stepsmentioning

confidence: 99%

Evidence for Implementation: HIV/HCV Coinfection and Pregnancy

Curtis

Chappell

2023

Curr HIV/AIDS Rep

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Purpose of Review In the context of the opioid epidemic, hepatitis C virus (HCV) infection prevalence is increasing among women of reproductive age. Pregnant people with HIV/HCV coinfection may be at increased risk of adverse pregnancy and neonatal outcomes, although research in this key population is lacking. Recent Findings Treatment with directly acting antivirals (DAAs) has transformed the clinical care for most patients with HCV. However, pregnant people were excluded from trials of these medications. A recent phase I study has shown promise with excellent safety profile for ledipasvir-sofosbuvir; demonstrating no episodes of perinatal transmission, 100% sustained virologic response, and no safety concerns. Summary Pregnancy represents a time of maximal interaction with the healthcare system and therefore an ideal window of opportunity to cure HCV. Current observational data regarding pregnant people who are co-infected with HCV and HIV suggest poor outcomes such as increased risk of preterm birth; however, there are no prospective and well-controlled studies to fully understand the impact of HIV/HCV coinfection on pregnancy. Phase 1 studies suggest that DAAs are well-tolerated and effective during pregnancy. Only through large, prospective clinical trials will we be able to understand the interaction of HCV and HIV during pregnancy and to evaluate safety and efficacy of DAAs in this key population.

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Section: Next Stepsmentioning

confidence: 99%

Evidence for Implementation: HIV/HCV Coinfection and Pregnancy

Curtis

Chappell

2023

Curr HIV/AIDS Rep

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“…A few small studies have shown rates ranging from 14% to 26% of spontaneous and persistent resolution in HCV viremia during the postpartum period. [20][21][22] This is speculated to be the outcome of immunologic changes [3] similar pharmacokinetic profile compared to non-pregnant women 100% SVR12 No neonatal or maternal safety concerns No MTCT Case Series: (Kushner et al, Gastro 2022) [14] [15] 11 women became pregnant on DAA, 8 contacted for more information; 7 discontinued after 4 wks and 1 after 8 wks; 1 MTCT; no safety concerns Case series (AbdAllah et al, Liver Int 2021): [16] that naturally occur during pregnancy, a relatively immunosuppressed state, followed by a surge in immunity after delivery. However, larger studies are required to investigate and understand this phenomenon further, as it could possibly influence the management of HCV in pregnancy.…”

Section: Management and Treatment Of Hepatitis C In Pregnancymentioning

confidence: 99%

“…Further, the mothers treated with DAA in this study were noted to have fewer pregnancy complications than those who did not receive treatment. [14] Table 1 provides a summary of human data on DAA use for HCV during pregnancy. These initial human studies provide reassuring data regarding the potential efficacy of DAA treatment in pregnancy with regards to possibly curing chronic HCV in this patient population, as well as eliminating the risk of MTCT of HCV.…”

Section: Management and Treatment Of Hepatitis C In Pregnancymentioning

confidence: 99%

Hepatitis C in pregnancy

Lange,

Schmidt,

Kushner

2023

Clinical Liver Disease

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“…Pilot studies have started with sofosbuvir/velpatasvir, a pangenotypic regimen that requires 12 weeks of dosing. AASLD, suggests that even in the absence of large-scale studies, treatment in pregnancy could be considered on a case-by-case basis [ 31 , 61 ]. In addition to the likely maternal clinical benefit [ 61 ], women may also want to be treated in pregnancy both for their own health and the health of the baby [ 62 ].…”

Section: Case-finding Care and Antiviral Transmission Preventionmentioning

confidence: 99%

“…AASLD, suggests that even in the absence of large-scale studies, treatment in pregnancy could be considered on a case-by-case basis [ 31 , 61 ]. In addition to the likely maternal clinical benefit [ 61 ], women may also want to be treated in pregnancy both for their own health and the health of the baby [ 62 ]. As pregnancy and prenatal care may present a women’s only opportunity to engage in medical care, provider hesitancy towards prescribing treatment due to minimal large-scale studies of their safety and efficacy during pregnancy, needs to be weighed against the risk associated with patient loss-to-follow up, further transmission and potential development of advanced liver disease [ 63 ].…”

Section: Case-finding Care and Antiviral Transmission Preventionmentioning

confidence: 99%

Hepatitis B and C in Pregnancy and Children: A Canadian Perspective

Mendlowitz

Feld

Biondi

2022

Viruses

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In 2016, the World Health Organization released a plan to eliminate viral hepatitis as a public health threat by 2030. For Canada to achieve the recommended decreases in HBV- and HCV-related new diagnoses and deaths, an increase in services is urgently required. Identifying those at risk of, or who have acquired HBV and HCV, remains a challenge, especially with the emergence of new priority populations such as pregnant persons and children. Importantly, prenatal, and pediatric care are times when individuals are often already engaged with the healthcare system, leading to the potential for opportunistic or co-localized care and interventions. At present, Canada may not be maximizing all available virologic tools that could lead to increases in prevention, identification, improved management, or even cure. Here, we describe the continuum of care that includes preconception, prenatal, postpartum, and pediatric stages; and identify current global and Canadian recommendations, findings, and opportunities for improvement.

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Treatment of Women With Hepatitis C Diagnosed in Pregnancy: a Co-Located Treatment Approach

Cited by 15 publications

References 5 publications

Evidence for Implementation: HIV/HCV Coinfection and Pregnancy

Evidence for Implementation: HIV/HCV Coinfection and Pregnancy

Hepatitis C in pregnancy

Hepatitis B and C in Pregnancy and Children: A Canadian Perspective

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