Academy Exchange

Hi all,

I was wondering if anyone had any experience in dealing with Hepatitis C in pregnancy. Had a patient referred to me recently, She belonged to one of our mid-levels who recently left the practice. The patient's chief complaint was: "I think I may be pregnant" and sure enough she was...She has a complicated history including drug abuse and a significant amount of mental health issues as well as some typical chronic medical complaints.

I have recently started treating Hepatitis C as part of my FQHC primary care practice. (I also sat for the HIV Specialist exam last month and am waiting on the edge of my seat for results.)

So, I ordered the labwork/work up for Hep C, I optimized her meds for pregnancy. But was wondering what the recommendations were for treating Hep C with DAA's in early pregnancy? The medications themselves don't have significant feto-toxicity, but then again, there aren't any significant recommendations or literature...just a few cases. The majority of feedback that I am getting is: wait until after pregnancy for treatment and recommend no breastfeeding. That's probably the route I'll take, but will wait for labs/assessment results. If she is pretty sick from the Hep-C (elevated LFT's, elevated Fibrosure/fibrosis score) it may be worth revisiting.

Thoughts?

--Sean

Hi all,

I was wondering if anyone had any experience in dealing with Hepatitis C in pregnancy. Had a patient referred to me recently, She belonged to one of our mid-levels who recently left the practice. The patient's chief complaint was: "I think I may be pregnant" and sure enough she was...She has a complicated history including drug abuse and a significant amount of mental health issues as well as some typical chronic medical complaints.

I have recently started treating Hepatitis C as part of my FQHC primary care practice. (I also sat for the HIV Specialist exam last month and am waiting on the edge of my seat for results.)

So, I ordered the labwork/work up for Hep C, I optimized her meds for pregnancy. But was wondering what the recommendations were for treating Hep C with DAA's in early pregnancy? The medications themselves don't have significant feto-toxicity, but then again, there aren't any significant recommendations or literature...just a few cases. The majority of feedback that I am getting is: wait until after pregnancy for treatment and recommend no breastfeeding. That's probably the route I'll take, but will wait for labs/assessment results. If she is pretty sick from the Hep-C (elevated LFT's, elevated Fibrosure/fibrosis score) it may be worth revisiting.

Thoughts?

--Sean

Hi all,

I was wondering if anyone had any experience in dealing with Hepatitis C in pregnancy. Had a patient referred to me recently, She belonged to one of our mid-levels who recently left the practice. The patient's chief complaint was: "I think I may be pregnant" and sure enough she was...She has a complicated history including drug abuse and a significant amount of mental health issues as well as some typical chronic medical complaints.

I have recently started treating Hepatitis C as part of my FQHC primary care practice. (I also sat for the HIV Specialist exam last month and am waiting on the edge of my seat for results.)

So, I ordered the labwork/work up for Hep C, I optimized her meds for pregnancy. But was wondering what the recommendations were for treating Hep C with DAA's in early pregnancy? The medications themselves don't have significant feto-toxicity, but then again, there aren't any significant recommendations or literature...just a few cases. The majority of feedback that I am getting is: wait until after pregnancy for treatment and recommend no breastfeeding. That's probably the route I'll take, but will wait for labs/assessment results. If she is pretty sick from the Hep-C (elevated LFT's, elevated Fibrosure/fibrosis score) it may be worth revisiting.

Thoughts?

--Sean

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Sean Leonard
Meadville PA
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Hi all,

I was wondering if anyone had any experience in dealing with Hepatitis C in pregnancy. Had a patient referred to me recently, She belonged to one of our mid-levels who recently left the practice. The patient's chief complaint was: "I think I may be pregnant" and sure enough she was...She has a complicated history including drug abuse and a significant amount of mental health issues as well as some typical chronic medical complaints.

I have recently started treating Hepatitis C as part of my FQHC primary care practice. (I also sat for the HIV Specialist exam last month and am waiting on the edge of my seat for results.)

So, I ordered the labwork/work up for Hep C, I optimized her meds for pregnancy. But was wondering what the recommendations were for treating Hep C with DAA's in early pregnancy? The medications themselves don't have significant feto-toxicity, but then again, there aren't any significant recommendations or literature...just a few cases. The majority of feedback that I am getting is: wait until after pregnancy for treatment and recommend no breastfeeding. That's probably the route I'll take, but will wait for labs/assessment results. If she is pretty sick from the Hep-C (elevated LFT's, elevated Fibrosure/fibrosis score) it may be worth revisiting.

Thoughts?

--Sean

Cautious/conservative approach would be to wait (as per others' suggestions here), however the limited data on DAA exposure later in pregnancy seems to be reassuring thus far.  Two sof/vel studies are underway in U.S. --  Dr. Sowah listed their NCT numbers below... the PK study in Pittsburgh with Catherine Chappell is still recruiting -- would that be of interest to you or your patient, if travel to study visits isn't prohibitive?  

Some have pointed out that pregnancy/postpartum may be a unique opportunity to treat since many pts are generally well-engaged in care during this time...loss to follow-up and disruptions in access to care/insurance are very real for my clinic population.  Thus, for very motivated patients who have been engaged in discussions about potential harms/benefits, what is known and unknown, etc. I don't think it would be wholly unreasonable to consider with close f/u and coordination... esp if there's compelling clinical reason to treat sooner rather than wait until she's no longer breastfeeding (in the event that she chooses to breastfeed).  With that said, most providers probably wouldn't opt to start treatment in pregnancy given limited data and experience so far.

------------------------------
Carolyn Chu
San Francisco General Hospital
San Francisco CA

Original Message:
Sent: 12-22-2020 07:06
From: Sean Leonard
Subject: Hepatitis C and Pregnancy

Hi all,

I was wondering if anyone had any experience in dealing with Hepatitis C in pregnancy. Had a patient referred to me recently, She belonged to one of our mid-levels who recently left the practice. The patient's chief complaint was: "I think I may be pregnant" and sure enough she was...She has a complicated history including drug abuse and a significant amount of mental health issues as well as some typical chronic medical complaints.

I have recently started treating Hepatitis C as part of my FQHC primary care practice. (I also sat for the HIV Specialist exam last month and am waiting on the edge of my seat for results.)

So, I ordered the labwork/work up for Hep C, I optimized her meds for pregnancy. But was wondering what the recommendations were for treating Hep C with DAA's in early pregnancy? The medications themselves don't have significant feto-toxicity, but then again, there aren't any significant recommendations or literature...just a few cases. The majority of feedback that I am getting is: wait until after pregnancy for treatment and recommend no breastfeeding. That's probably the route I'll take, but will wait for labs/assessment results. If she is pretty sick from the Hep-C (elevated LFT's, elevated Fibrosure/fibrosis score) it may be worth revisiting.

Thoughts?

--Sean

Hi all,

I was wondering if anyone had any experience in dealing with Hepatitis C in pregnancy. Had a patient referred to me recently, She belonged to one of our mid-levels who recently left the practice. The patient's chief complaint was: "I think I may be pregnant" and sure enough she was...She has a complicated history including drug abuse and a significant amount of mental health issues as well as some typical chronic medical complaints.

I have recently started treating Hepatitis C as part of my FQHC primary care practice. (I also sat for the HIV Specialist exam last month and am waiting on the edge of my seat for results.)

So, I ordered the labwork/work up for Hep C, I optimized her meds for pregnancy. But was wondering what the recommendations were for treating Hep C with DAA's in early pregnancy? The medications themselves don't have significant feto-toxicity, but then again, there aren't any significant recommendations or literature...just a few cases. The majority of feedback that I am getting is: wait until after pregnancy for treatment and recommend no breastfeeding. That's probably the route I'll take, but will wait for labs/assessment results. If she is pretty sick from the Hep-C (elevated LFT's, elevated Fibrosure/fibrosis score) it may be worth revisiting.

Thoughts?

--Sean

Hi all,

I was wondering if anyone had any experience in dealing with Hepatitis C in pregnancy. Had a patient referred to me recently, She belonged to one of our mid-levels who recently left the practice. The patient's chief complaint was: "I think I may be pregnant" and sure enough she was...She has a complicated history including drug abuse and a significant amount of mental health issues as well as some typical chronic medical complaints.

I have recently started treating Hepatitis C as part of my FQHC primary care practice. (I also sat for the HIV Specialist exam last month and am waiting on the edge of my seat for results.)

So, I ordered the labwork/work up for Hep C, I optimized her meds for pregnancy. But was wondering what the recommendations were for treating Hep C with DAA's in early pregnancy? The medications themselves don't have significant feto-toxicity, but then again, there aren't any significant recommendations or literature...just a few cases. The majority of feedback that I am getting is: wait until after pregnancy for treatment and recommend no breastfeeding. That's probably the route I'll take, but will wait for labs/assessment results. If she is pretty sick from the Hep-C (elevated LFT's, elevated Fibrosure/fibrosis score) it may be worth revisiting.

Thoughts?

--Sean

Hi Sean, I treat HIV and HCV and have had a couple of patients in a very similar situation except both decided to terminate their pregnancies. I use the discussion in the national Hep C curriculum as a guide. Agree you need to stage her for cirrhosis which has implications for her health during pregnancy if she opts to continue. Currently because of lack of data on DAA safety in pregnancy the recommendation Is not to treat, as the risk of vertical transmission is low, also some women spontaneously clear HCV post-childbirth. I think she just needs counseling about it as you are doing. See the section on perinatal HCV transmission in the online curriculum: Core Concepts - Counseling for Prevention of HCV Transmission - Screening and Diagnosis of Hepatitis C Infection - Hepatitis C Online

Regards,

Rachel Picone DNP

Hi all,

I was wondering if anyone had any experience in dealing with Hepatitis C in pregnancy. Had a patient referred to me recently, She belonged to one of our mid-levels who recently left the practice. The patient's chief complaint was: "I think I may be pregnant" and sure enough she was...She has a complicated history including drug abuse and a significant amount of mental health issues as well as some typical chronic medical complaints.

I have recently started treating Hepatitis C as part of my FQHC primary care practice. (I also sat for the HIV Specialist exam last month and am waiting on the edge of my seat for results.)

So, I ordered the labwork/work up for Hep C, I optimized her meds for pregnancy. But was wondering what the recommendations were for treating Hep C with DAA's in early pregnancy? The medications themselves don't have significant feto-toxicity, but then again, there aren't any significant recommendations or literature...just a few cases. The majority of feedback that I am getting is: wait until after pregnancy for treatment and recommend no breastfeeding. That's probably the route I'll take, but will wait for labs/assessment results. If she is pretty sick from the Hep-C (elevated LFT's, elevated Fibrosure/fibrosis score) it may be worth revisiting.

Thoughts?

--Sean

Hi all,

I was wondering if anyone had any experience in dealing with Hepatitis C in pregnancy. Had a patient referred to me recently, She belonged to one of our mid-levels who recently left the practice. The patient's chief complaint was: "I think I may be pregnant" and sure enough she was...She has a complicated history including drug abuse and a significant amount of mental health issues as well as some typical chronic medical complaints.

I have recently started treating Hepatitis C as part of my FQHC primary care practice. (I also sat for the HIV Specialist exam last month and am waiting on the edge of my seat for results.)

So, I ordered the labwork/work up for Hep C, I optimized her meds for pregnancy. But was wondering what the recommendations were for treating Hep C with DAA's in early pregnancy? The medications themselves don't have significant feto-toxicity, but then again, there aren't any significant recommendations or literature...just a few cases. The majority of feedback that I am getting is: wait until after pregnancy for treatment and recommend no breastfeeding. That's probably the route I'll take, but will wait for labs/assessment results. If she is pretty sick from the Hep-C (elevated LFT's, elevated Fibrosure/fibrosis score) it may be worth revisiting.

Thoughts?

--Sean

Hi all,

I was wondering if anyone had any experience in dealing with Hepatitis C in pregnancy. Had a patient referred to me recently, She belonged to one of our mid-levels who recently left the practice. The patient's chief complaint was: "I think I may be pregnant" and sure enough she was...She has a complicated history including drug abuse and a significant amount of mental health issues as well as some typical chronic medical complaints.

I have recently started treating Hepatitis C as part of my FQHC primary care practice. (I also sat for the HIV Specialist exam last month and am waiting on the edge of my seat for results.)

So, I ordered the labwork/work up for Hep C, I optimized her meds for pregnancy. But was wondering what the recommendations were for treating Hep C with DAA's in early pregnancy? The medications themselves don't have significant feto-toxicity, but then again, there aren't any significant recommendations or literature...just a few cases. The majority of feedback that I am getting is: wait until after pregnancy for treatment and recommend no breastfeeding. That's probably the route I'll take, but will wait for labs/assessment results. If she is pretty sick from the Hep-C (elevated LFT's, elevated Fibrosure/fibrosis score) it may be worth revisiting.

Thoughts?

--Sean