Hepatitis C Virus in Pregnancy: Case Reports and Literature Review

Background: Hepatitis C virus (HCV) is now recognized as the cause of 90% of non-A, non-B (NANB) hepatitis. This virus is responsible for a large percentage of chronic persistent and chronic active hepatitis in the United States. Parenteral and sexual transmission are well described, so a significant population of pregnant patients is at risk. Vertical transmission of the virus to the fetus is dependent upon the level of maternal viremia.Case: The cases described in the following report demonstrate that fulminant disease may present in pregnancy. They also demonstrate the cofactors promoting the severity of illness, methods of diagnosis, potential treatment, and outcome of the infection.Conclusion: HCV may be encountered in pregnancy. Although most acute-phase illness will be self limiting, some patients will manifest liver failure during gestation. Because vertical transmission to the fetus is possible, the pediatrician should be informed of the maternal disease. Chronic hepatitis is almost the rule rather than the exception, so patients require close postpartum follow-up. Interferon, which may alter the course of the chronic disease, has been used on rare occasions in pregnancy.

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Optimizing Hepatitis C Virus (HCV) Treatment in a US Colocated HCV/Opioid Agonist Therapy Program

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa310 ◽

2020 ◽

Vol 7 (10) ◽

Author(s):

Jackie Habchi ◽

Aurielle M Thomas ◽

Sophie Sprecht-Walsh ◽

Elenita Arias ◽

Jeffrey Bratberg ◽

...

Keyword(s):

United States ◽

Hepatitis C Virus ◽

Hepatitis C ◽

Methadone Maintenance ◽

The United States ◽

Opioid Use ◽

Agonist Therapy ◽

Opioid Agonist ◽

Opioid Agonist Therapy

Abstract Background A minority of patients with opioid use disorder are treated for hepatitis C virus infection (HCV). While colocated HCV and opioid agonist therapy (OAT) along with harm reduction can facilitate prevention and cascade to cure, there are few real-world examples of such embedded care models in the United States in the direct-acting antiviral (DAA) era. Methods We conducted a retrospective chart review to determine sustained virologic response (SVR) and reinfection rates during the first 5-year period of DAA availability among individuals tested and treated on-site at Rhode Island’s only nonprofit methadone maintenance program. Results Of 275 who initiated DAAs, the mean age (range) was 43 (22–71) years, 34.5% were female, 57.5% had genotype 1a, 23.3% had cirrhosis, and 92% were Medicaid recipients. SVR was 85.0% (232/273), while modified intent-to-treat SVR was 93.2% (232/249); 17 patients did not achieve SVR, 2 awaited SVR 12 weeks post-end-of-treatment, and 24 were lost to follow-up. Thirty reinfections were identified over 375.5 person-years of follow-up (rate, 7.99/100 person-years). The median time to first reinfection (interquartile range) was 128 (85.25–202.5) days. Before July 1, 2018, 72 patients accessed DAAs over 3.7 years; after Medicaid DAA restrictions were lifted, 109 patients accessed DAAs over 1.3 years. The Prior Authorization (PA) process requires many steps, differing across 11 RI insurers, taking 45–120 minutes per patient. Conclusions DAA treatment was effective among a marginalized population in an urban colocated OAT/HCV program. Removing DAA restrictions facilitates treatment initiation. The PA process remains a modifiable barrier to expanding capacity in the United States.

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Obstetric risks and vertical transmission of hepatitis C virus infection in pregnancy

Acta Obstetricia Et Gynecologica Scandinavica ◽

10.1080/j.1600-0412.2000.079007543.x ◽

2000 ◽

Vol 79 (7) ◽

pp. 543-547 ◽

Cited By ~ 26

Author(s):

PETER HILLEMANNS ◽

CHRISTIAN DANNECKER ◽

RAINER KIMMIG ◽

UWE HASBARGEN

Keyword(s):

Hepatitis C Virus ◽

Hepatitis C ◽

Virus Infection ◽

Vertical Transmission ◽

Hepatitis C Virus Infection ◽

In Pregnancy

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Outcomes of a Pharmacist-Led Hepatitis C Virus Treatment Program in an Urban Safety-Net Health System, Chicago, 2017-2019

Public Health Reports ◽

10.1177/00333549211015664 ◽

2021 ◽

pp. 003335492110156

Author(s):

Bijou R. Hunt ◽

Hollyn Cetrone ◽

Sharon Sam ◽

Nancy R. Glick

Keyword(s):

Hepatitis C Virus ◽

Hepatitis C ◽

Health System ◽

Treatment Program ◽

Safety Net ◽

The United States ◽

Hcv Treatment ◽

Treatment Cascade ◽

Urban Safety

Objective A recommendation in March 2020 to expand hepatitis C virus (HCV) screening to all adults in the United States will likely increase the need for HCV treatment programs and guidance on how to provide this service for diverse populations. We evaluated a pharmacist-led HCV treatment program within a routine screening program in an urban safety-net health system in Chicago, Illinois. Methods We collected data on all patient treatment applications submitted from January 1, 2017, through June 30, 2019, and assessed outcomes of and patient retention in the treatment cascade. Results During the study period, 203 HCV treatment applications were submitted for 187 patients (>1 application could be submitted per patient): 49% (n = 91) were aged 55-64, 62% (n = 116) were male, 67% (n = 125) were Black, and 15% (n = 28) were Hispanic. Of the 203 HCV treatment applications, 87% (n = 176) of patients were approved for treatment, 91% (n = 161) of whom completed treatment. Of the 161 patients who completed treatment, 81% (n = 131) attended their sustained virologic response (SVR) follow-up visit, 98% (n = 129) of whom reached SVR. The largest drop in the treatment cascade was the 19% decline from receipt of treatment to SVR follow-up visit. Conclusion The pharmacist-led model for HCV treatment was effective in navigating patients through the treatment cascade and achieving SVR. Widespread implementation of pharmacist-led HCV treatment models may help to hasten progress toward 2030 HCV elimination goals.

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Agreement in Pathologic Interpretation of Liver Biopsy Specimens in Posttransplant Hepatitis C Infection

Archives of Pathology & Laboratory Medicine ◽

10.5858/1999-123-0143-aipiol ◽

1999 ◽

Vol 123 (2) ◽

pp. 143-145

Author(s):

Zobair M. Younossi ◽

Navdeep Boparai ◽

Terry Gramlich ◽

John Goldblum ◽

Peggy George ◽

...

Keyword(s):

Chronic Hepatitis ◽

Hepatitis C Virus ◽

Hepatitis C ◽

Liver Biopsy ◽

Chronic Hepatitis C ◽

The United States ◽

Intraobserver Agreement ◽

Hepatitis C Infection ◽

Biopsy Specimens

Abstract Hepatitis C virus–related disease is rapidly becoming the most common indication for orthotopic liver transplant (OLT) in the United States. Although post-OLT hepatitis C viremia is universal, 40% to 60% of patients develop recurrent chronic hepatitis C. Distinguishing recurrent chronic hepatitis C infection from acute rejection may be difficult because of overlapping histopathologic features. To improve our diagnostic accuracy we undertook a study to determine interobserver and intraobserver agreement between pathologists examining post-OLT liver biopsy specimens in patients from our transplant database. Clinical data and microscopic sections from 26 patients with hepatitis C virus–related OLT were reviewed. Biopsy specimens were obtained because of abnormal liver enzymes (21/26) or routine post-OLT follow-up (5/26), representing both early (18 ± 11 days) and late (252 ± 206 days) post-OLT periods. Unidentified sections were examined by an experienced pathologist in a randomly assigned order and reexamined 6 weeks later in the same fashion by the initial reviewer and a second experienced pathologist. Interobserver and intraobserver agreement was calculated using κ statistic. The intraobserver agreement was 81% with a κ coefficient of 0.67 (P = .001). The interobserver agreement was 78% with a κ coefficient of 0.60 (P < .001). The early post-OLT biopsy specimens (18 ± 11 days) were the most difficult to interpret.

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