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hep c replicates better in pregnant women and their babies?
Nov 7, 2013

Hi Dr. Taylor!

Have you seen this study?

http://www.medicaldaily.com/pregnancy-could-help-hepatitis-c-develop-hardier-strain-viruses-able-replicate-faster-could-be

What do you make of it -- and what this mean for women who are pregnant and coinfected with HIV and hep C?

Will new hep C treatments in the pipeline be OK for women to take while pregnant, and would this protect their babies from infection? I've read current treatments aren't great during pregnancy. I'm just a little confused. I can't see anywhere in this study summary whether these women were treated for their hep C.

Any light you can shed on this for us would be awesome. Thanks so much for the work you do here!

Response from Dr. Taylor

I had not seen this study. It involves only 2 women, thus while intriguing, I would not draw any conclusions. MANY health conditions may be exacerbated by pregnancy (for example, hepatitis E), and others may be brought on by pregnancy (such as diabetes). In a way, pregnancy is a state of some immune suppression our immune system must be turned down so that we do not reject the 'other,' the genetically different fetus. Of note, some health conditions can get better in pregnancy.

Hepatitis C is rarely spread from a woman who is pregnant to her developing fetus. The risk is about 2% -- that is, 2 infants out of every 100. The risk is higher if the woman is infected with both HIV and hepatitis C. In this case, it is important that a woman confer with her HIV physician and take antiretrovirals (HIV pills) that are safe in pregnancy (there ARE HIV pill that are very safe in pregnancy, and that can decrease the likelihood that HIV will be passed to the baby). The goal is achieving non-detectable HIV viral load. This decreases the risk of passing HIV to the baby. If the baby is HIV-uninfected, the chance that the baby will acquire hepatitis C is lower.

The new hepatitis C pills are not safe to take in pregnancy, as far as we know at this point. A woman may take SOME of the hepatitis pills way (MANY MONTHS) before pregnancy, and try to be cured before becoming pregnant. Some hepatitis C pills, importantly an old one, ribavirin, can cause severe damage to a developing fetus. It should not be take for at least 9 months before a pregnancy, although I caution people to let this medication clear away for a year before becoming pregnant. Ribavirin can even cause severe birth defects when a man takes this pill and has vaginal intercourse (penis in the vagina) with a woman who is pregnant.

Interferon injections can induce a spontaneous abortion (can make the pregnancy end), so are also not safe in pregnancy.

Since hepatitis C is spread by blood, some obstetrical procedures such as fetal scalp monitoring, should be avoided in women with hepatitis C. Talk with your doctor about this. Importantly, breast feeding is safe with hepatitis C and does not spread this virus (although if the nipples are cracked/bleeding it may be important to take a break until this heals). Since breastfeeding is so important for health, for the woman and the baby, unless there is another reason not to breastfeed (HIV for example), women with hepatitis C should be encouraged to breastfeed. C-section is also NOT recommended for women with hepatitis C to reduce passage of the virus to the baby as this is NOT the case, and should be performed NOT because of hepatitis C but only if there are other reasons.



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