Digestive Disease Week 2020-Tu 1637Longitudinal HCV care of pregnant patients in an "obstetric hepatology clinic"

Conference Paper

Background: Hepatitis C virus (HCV) screening has been recommended in patients born between 1945 and 1965 due to increased HCV incidence. However, HCV infection is occurring at an increased rate in young adults, particularly in young women. As this cohort includes women of childbearing age, there is now emphasis regarding HCV screening and management in pregnant women. Safety data on HCV therapy in pregnancy are lacking, but identification and referral of HCV-positive pregnant patients for HCV-related care offers an opportunity to ensure that they will seek early postpartum HCV treatment. This study investigated longitudinal HCV-related medical care in pregnant women who were referred into an “obstetric” hepatology clinic that specializes in the care of pregnant women with liver disease. Methods: In this retrospective study, an institutional web-based research query tool was used to identify patients with hepatitis C-related ICD codes who were referred into and seen in the study provider’s clinic. Demographic and clinical data were abstracted from the electronic medical record. Results: Twelve patients who were referred to and attended at least one session of the study provider’s clinic during 2015 – 2017 were identified. The mean age of patients was 29 years, and 8 (66.7%) had a history of illicit or opioid drug abuse, with 6 (50%) on buprenorphine or methadone. Eleven (91.7%) patients had Medicaid at referral; one had private insurance. Eight patients (66.7%) completed pregnancy via spontaneous vaginal delivery; the remaining underwent Cesarean section. Eleven patients (91.7%) had detectable HCV RNA at referral; one had a positive HCV antibody but no detectable HCV RNA at referral, which was confirmed during the initial clinic visit. Observed HCV genotypes in this cohort were genotype 1 (n =4), genotype 2 (n = 1), and genotype 3 (n = 2). HCV genotype was unknown in the 4 other patients with chronic HCV infection. Among 11 patients with confirmed chronic HCV, 4 patients underwent HCV therapy (3 patients took glecaprevir-pibrentasvir; one patient took ledipasvir-sofosbuvir). Three patients achieved sustained virologic response (SVR). One patient did not undergo requested testing to confirm SVR. The other 7 patients with chronic HCV did not maintain follow up to allow for institution of HCV therapy. Conclusion: 36.3% of women with chronic HCV in this clinic underwent HCV therapy. This low rate of treatment may have been related to limitations on insurance coverage as women transitioned into postpartum healthcare. Nonetheless, this clinic provides an opportunity for HCV infected women to gain education about hepatitis C and access to HCV treatment at an early stage of life, thus helping to prevent progression to advanced HCV-related liver disease

Full Text

Duke Authors

Cited Authors

  • Livingston, E; Mosquera, D; Brady, C

Published Date

  • May 5, 2020

Published In

Volume / Issue

  • 158 / 6

Start / End Page

  • s-1141 - s-1141

Published By

International Standard Serial Number (ISSN)

  • 0016-5085

Digital Object Identifier (DOI)

  • 10.1016/S0016-5085(20)33523-X

Conference Name

  • Digestive Disease Week

Conference Location

  • Chicago IL cancelled- Virtual due to COVID

Conference Start Date

  • May 2, 2020

Conference End Date

  • May 5, 2020