Hepatitis C Virus Prevalence and Outcomes Among Pregnant Women Who Inject Drugs

Author: Sanjeevani Tomar Anthony Martinez

Theme: Clinical Research Year: 2022

Background: Hepatitis C virus (HCV) infections in the United States have increased over the past decade,
particularly among persons 20–39 years old, partly attributable to injection drug use associated with the
opioid epidemic. This has led to a rise in the prevalence of HCV in pregnancy from 1.8 to 5.1 per 1,000
live births: ~60–75% of pregnant women with a history of opioid and injection drug use are HCV+. Better
identification of these women can ensure timely care to prevent vertical transmission.

Methods: We retrospectively reviewed medical charts for pregnant women who inject drugs identified
as HCV+ between January 2017 and May 2022 at a hepatology clinic known as “La Bodega,” which treats
individuals with HCV and opiate dependence.

Results: The numbers of HCV+ pregnant women with injection drug use increased over the study period. Among these 27 women, 7 (25.9%) missed the initial appointment, 3 (11.1%) were lost to
follow-up before treatment initiation, 1 (3.7%) was denied insurance coverage for treatment, and 1
(3.7%) is pending evaluation. HCV spontaneously resolved in 3 patients (11.1%).
Among the 12 women that were treated, genotype 1a was the most common HCV type.
Treatments occurred during the 3rd trimester of pregnancy in 3/12 women (25%) and during the
postpartum period in 9/12 (75%) women (of the latter, 3 were lost to follow-up). Treatments consisted
of sofosbuvir-velpatasvir (8/12 [66.6%]), sofosbuvir-ledipasvir (1/12 [8.3%]), sofosbuvir-velpatasvirvoxilaprevir (2/12 [16.7%]), and glecaprevir-pibrentasvir (1/12 [8.3%]). A sustained virologic response to
treatment was attained in 7/12 (58.3%) women, and 2/12 (16.7%) are currently on treatment.

Conclusion: HCV cases among pregnant women who inject drugs is increasing. More research is needed
regarding treatment among pregnant women. Treatment in the 3rd trimester is feasible thus preventing
vertical transmission. Linkage to care may have been impacted by COVID.

Disclosure of Interest Statement: Dr. Martinez has received funding from Gilead, AbbVie, Intercept, and
Antios, and Eisai. Dr. Tomar has no conflicts to report.

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