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HCV in Pregnancy
Clearing the Path: HCV Screening and Treatment During Pregnancy

Released: October 31, 2024

Expiration: October 30, 2025

Tatyana Kushner
Tatyana Kushner, MD, MSCE
Activity Information

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Key Takeaways
  • Guidelines recommend universal hepatitis C virus (HCV) screening in all pregnant persons.
  • HCV treatment is recommended before pregnancy, if possible, and can be considered on a case-by-case basis after patient–physician discussion during pregnancy.

Universal hepatitis C virus (HCV) screening during pregnancy is recommended by several guidelines including the Centers for Disease Control and Prevention, United States Preventive Services Task Force, American Association for the Study of Liver Diseases (AASLD), Infectious Diseases Society of America (IDSA), and American College of Obstetricians and Gynecologists.

However, HCV screening recommendations are incomplete, and there are several opportunities to enhance HCV screening and linkage to care, both in prenatal care settings and sexual/reproductive health clinics. Here are some ideas of how to capitalize on these opportunities, many more of which we will explore in an upcoming virtual workshop.

Early HCV Diagnosis
To improve HCV screening at my practice site, we integrated HCV testing into the prenatal laboratory panel. Although this strategy has effectively increased testing rates, it may not be feasible to adopt at other clinics, such as satellite obstetric practices that may require use of a new panel.

Regardless of its feasibility, the advantage of early HCV identification is that it maximizes opportunities for education, treatment and/or referral, and reduces the risk of mother-to-child transmission. Therefore, whenever possible, HCV testing and treatment is recommended before pregnancy.

The AASLD/IDSA guideline states “for women of reproductive age with known HCV infection, antiviral therapy is recommended before considering pregnancy whenever practical and feasible, to reduce the risk of HCV transmission to future offspring.” In response, I believe sexual/reproductive health clinics should implement HCV testing and plan treatment before potential conception.

HCV Treatment During Pregnancy
After screening, there should be a clear pathway to treatment—either colocated at the practice or by referral to a specialty practice. In the maternal care setting, HCV treatment with direct-acting antiviral for treatment in pregnancy is being investigated in several clinical trials. The AASLD/IDSA guideline also mentions that “despite the lack of a recommendation, treatment can be considered during pregnancy on an individual basis after a patient–physician discussion about the potential risks and benefits.” 

I have found that many individuals are interested in pursuing HCV treatment during pregnancy, especially if it benefits infants by reducing mother-to-child transmission. At our site, we developed an interdisciplinary protocol for HCV treatment during pregnancy that includes follow-up with obstetricians, hepatologists, and pediatric infectious disease specialists.

Clear Paths to HCV Elimination
There are very few other practices across the country that offer HCV treatment to pregnant individuals. More data on the safety and efficacy of HCV treatment during pregnancy are eagerly anticipated.

If HCV treatment does not occur during pregnancy, HCPs should ensure another clear pathway to postpartum follow-up and care. Studies indicate extremely low rates of postpartum linkage to HCV treatment for those who test positive for HCV during pregnancy, even in high-risk individuals such as those with opioid use disorder.

Now that there are recommendations for universal HCV screening in pregnancy, it is important to have systems or clear pathways in place to ensure that those who test positive are properly connected to treatment. It is also crucial to ensure that their infants receive appropriate screening for HCV transmission. Addressing HCV in these care settings is a critical aspect towards HCV elimination. 

Learn More
To learn more about overcoming barriers to HCV screening and care in sexual/reproductive health clinics, join me and my colleague, Dr Howard Lee, and patient advocate, Andrew Reynolds at our virtual workshop. 

 Your Thoughts?
How often are you providing or offering screening and treatment recommendations for HCV in pregnant individuals? Join the discussion by leaving a comment.