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Real-World Experience of Hepatitis C Treatment With Glecaprevir-Pibrentasvir During Pregnancy
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Abstract
Guidelines endorse antenatal hepatitis C virus treatment following shared decision making. No clinical trial or real-world data exist for glecaprevir-pibrentasvir (GLE/PIB). We report our experience with prenatal GLE/PIB in 14 patients. Ten patients completed treatment; all achieved virologic response by or at delivery, with no maternal or neonatal safety concerns.
This retrospective report describes outcomes in 14 pregnant individuals started on GLE/PIB in the second or third trimester of pregnancy, of whom 10 successfully completed therapy. These findings suggest that GLE/PIB may be effective, safe, and well tolerated in pregnancy. They findings also support the IDSA/AASLD guidelines stating that DAAs may be offered to pregnant patients though shared decision making.
These findings are particularly important because the annual rate of acute HCV tripled in the United States from 2008 to 2018, fueled by substance use [6]. In addition to long-term hepatic morbidity, HCV in pregnancy is associated with adverse obstetric outcomes, including perinatal transmission (estimated at 8%) [7], ICP, preterm birth, and neonatal death [8]. HCV also affects obstetric delivery management.
In conclusion, our findings provide real-world data supporting the IDSA/AASLSD guidelines stating that DAAs, including GLE/PIB, may be offered to pregnant patients with HCV. Additional studies are needed to improve uptake of share decision-making approaches to offering DAA treatment in pregnancy, in order to improve patient outcomes and reduce perinatal transmission of HCV.
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