Addressing treatment needs for hepatitis C in pregnancy and infancy

Hepatitis C cases have been rising in the United States over the past decade, driven by the ongoing opioid epidemic and needle sharing, with the highest rates of infection among young people, including women of childbearing age. If left untreated, hepatitis C can lead to acute and chronic hepatitis, increasing the risk of liver cancer, liver failure and other diseases.

During pregnancy, hepatitis C is associated with low birth weight, intrahepatic cholestasis of pregnancy, and preterm birth. The standard of care for treating hepatitis C in pregnant women is to initiate postpartum treatment, which can begin immediately after delivery, but this approach has significant limitations.

Under the guidance of experts at Northwestern Medicine and Ann & Robert H. Lurie Children’s Hospital of Chicago, an innovative pregnancy treatment plan is now being offered that allows pregnant women to cure hepatitis C during prenatal care, which may also significantly alleviate or even Eliminates the risk of transmitting hepatitis C to your baby.

“Our goal is very simple – we want to improve the lives of pregnant women with hepatitis C and their babies,” said Lynn Yee, MD, a maternal-fetal medicine specialist and director of Northwestern Medicine’s Women’s Infectious Diseases Program. “Although treatment during pregnancy is not yet common, our professional societies support a shared decision-making process that includes discussions with patients about what is known and what is not known.

“We believe that by including pregnant women in hepatitis C research and treatment programs, we will work towards the public health goal of eliminating hepatitis C and address the historical problem of excluding pregnant women from life-changing treatments.”

“Healthcare providers overall still lack awareness about the impact of hepatitis C on pregnancy and its transmission to the baby,” said Ravi Jhaveri, MD, a pediatrician and chief of the Division of Pediatric Infectious Diseases at Lurie Children’s Hospital. “Because of the prevalence of hepatitis C, Infections are often associated with injection drug use, so there is still a lot of stigma and judgment from healthcare providers that prevents them from having open conversations. We want every pregnant patient to be tested for hepatitis C, and those who test positive to be tested for hepatitis C quickly Can get tested.” Treatment is provided. ”

Examine and treat pregnant patients

The greatest risk of contracting hepatitis C belongs to workers who come into contact with human blood, body fluids, or needles; use intravenous or intravenous drugs; have unprotected sex; contract HIV; this is why most people with hepatitis C do not have any symptoms Testing is so important during pregnancy.

In 2020, guidelines implemented by the U.S. Preventive Services Task Force recommended that all pregnant women receive hepatitis C antibody testing during routine prenatal care. Patients with evidence of hepatitis C antibodies will undergo further testing and be referred to the Northwestern Medicine Women’s Infectious Diseases Program.

In this specialized program, the first step in treatment planning for patients with evidence of chronic hepatitis C is in-depth counseling and shared decision-making about the risks, benefits, and alternative treatment options during and after pregnancy. Northwestern Medicine was the first program in Chicago and one of the few nationwide to offer a treatment program to eligible patients, and it serves as a referral center for pregnant women with hepatitis C.

“While postpartum therapy is a good plan for many patients, this approach has significant limitations,” Dr. Yee said. “Many people lose contact with health care after giving birth due to a variety of factors. For example, in many states, pregnant women on Medicaid lose Medicaid 60 days after delivery, so the time to activate Medicaid may be limited. For others, the competing priorities and burdens of being a parent take precedence over taking care of their own health.

“However, we know from a large body of research that pregnancy is a time of heightened motivation to engage in health care and improve health, making it an ideal window of opportunity for treatment. Treatment during pregnancy means more than just a cure for pregnant women undergoing prenatal care The incidence of hepatitis C during the process is high, but achieving cure before delivery is also likely to significantly reduce or eliminate the risk of transmitting hepatitis C to the baby, which would represent an incredible public health advance.”

When patients need treatment, doctors and infectious disease pharmacists work to obtain coverage for the treatment. Medication is then started, taken once daily for 8-12 weeks. Laboratory monitoring is performed before, during, and after the treatment course to ensure the absence of side effects and to monitor viral recovery.

Specialists in Northwestern Medicine’s Women’s Infectious Diseases Program also work closely on studies involving the responsible inclusion of pregnant women in hepatitis C research and treatment programs and are able to refer patients to research programs when needed.

To date, experts in the Women’s Infectious Diseases Program have treated about five pregnant patients with hepatitis C. In all cases, patients completed the course of treatment during pregnancy and achieved a sustained virological response—also known as cure.

One of the patients, Kareena Wasserman, was shocked to find out she tested positive for hepatitis C while pregnant with her second child. She underwent a treatment plan in her third trimester, cleared the virus, and Wasserman gave birth to a healthy baby girl at Northwestern Medicine Prentice Women’s Hospital.

“I honestly don’t know how I contracted hepatitis C, especially since my husband and oldest child do not have the virus,” Wasserman said. “But when Dr. Ye told me there was a cure Pathways – not just for myself, but for babies – I know the rewards outweigh any risks. I want other patients to know they are not alone and that there is a treatment.” Northwestern Medicine offers safe treatment options. ”

CDC’s new testing recommendations for infants

Although infants clear the hepatitis C virus at a higher rate than adults, it can cause scarring and fibrosis of the liver if not tested and treated for several years. Until now, testing of babies was often delayed until after 18 months due to interference with hepatitis C antibodies being passed from mother to baby late in pregnancy, and long delays meant most babies were never tested.

This November, the Centers for Disease Control and Prevention (CDC) will release new guidelines for hepatitis C testing in infants. Dr. Jhaveri co-authored an opinion piece on the CDC’s new testing recommendations, published in Pediatrics November 1st.

“The CDC has simplified and clarified their testing guidance. Infants exposed to hepatitis C during pregnancy should have a hepatitis C virus (HCV) RNA PCR test when they are 2 to 6 months old. If the result is negative, And they don’t need further testing if they have hepatitis C. If the result is positive, they should contact a health care provider who can follow them, retest later, and ultimately receive treatment at age three,” Dr. Jhaveri said.

“I think these new recommendations will significantly improve our ability to get the right tests done. They will reduce confusion among providers about when to send which test, reduce the time to final testing, and leverage existing newborn visits to send Detection.”

Northwestern Medicine and Lurie Children’s Hospital will soon be part of a national study by the International Maternal Pediatric Adolescent AIDS Clinical Trials Network (IMPAACT) that will recruit eligible patients who have been diagnosed with hepatitis C and are currently undergoing Patients receiving treatment.

The team also received funding from the CDC to design a video-based learning model for physicians to learn about key aspects of hepatitis C in pregnancy and early infancy, how to improve decision-making conversations with patients, and how to initiate hepatitis C treatment.

“As our society becomes increasingly focused on social justice, we believe there are long-standing injustices here,” Dr. Jhaveri said. “Due to historical practices, pregnant patients have been excluded from hepatitis C research and treatment. We hope our work helps address this injustice and allow pregnant patients to easily and openly receive hepatitis C treatment , without running into the barriers that currently exist.”