Population: Pregnant adults with HCV infection.
Organizations
AASLD 2020, EASL 2020
Recommendations
Evaluation
–Screen all pregnant women for HCV infection at the start of prenatal care.
–Obtain HCV RNA and routine liver function tests at the start of pregnancy to help assess disease severity.
–In HCV-infected pregnant women with pruritus or jaundice, evaluate for intrahepatic cholestasis of pregnancy.
Management
– Offer treatment to all women with HCV infection prior to becoming pregnant to reduce the risk of vertical transmission.
–Do not treat during pregnancy without a compelling indication and collaboration with obstetric and gastroenterology colleagues.
–If HCV-infected women with cirrhosis, consult a maternal-fetal medicine (ie, high-risk pregnancy) obstetrician.
–Do not restrict breastfeeding in HCV-infected mothers unless the mother has cracked, damaged, or bleeding nipples or if coinfected with HIV.
–Reassess women with HCV infection after delivery with an HCV-RNA assay to see if they have spontaneously cleared.
Practice Pearl
• There is no known way to reduce mother-to-child-transmission risk for HCV-infected women.
Sources
–https://doi.org/10.1002/hep.31060
–https://doi.org/10.1016/j.jhep.2020.08.018
Population: Infants exposed to HCV.
Organizations
AASLD 2020, EASL 2020
Recommendations
–Test all children born to HCV-infected women for HCV using an antibody-based test at or after 18 mo of age.
–HCV RNA assay testing can be used in the first year of life but optimal timing is unknown.
–If HCV antibody is positive at 18 mo, test with HCV RNA assay at 3 y of age to confirm chronic HCV infection.
–If a child has HCV, test other siblings born from the same mother.
Sources