Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA.
Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, USA.
Curr HIV/AIDS Rep. 2023 Feb;20(1):1-8. doi: 10.1007/s11904-022-00643-9. Epub 2023 Jan 18.
In the context of the opioid epidemic, hepatitis C virus (HCV) infection prevalence is increasing among women of reproductive age. Pregnant people with HIV/HCV coinfection may be at increased risk of adverse pregnancy and neonatal outcomes, although research in this key population is lacking.
Treatment with directly acting antivirals (DAAs) has transformed the clinical care for most patients with HCV. However, pregnant people were excluded from trials of these medications. A recent phase I study has shown promise with excellent safety profile for ledipasvir-sofosbuvir; demonstrating no episodes of perinatal transmission, 100% sustained virologic response, and no safety concerns. Pregnancy represents a time of maximal interaction with the healthcare system and therefore an ideal window of opportunity to cure HCV. Current observational data regarding pregnant people who are co-infected with HCV and HIV suggest poor outcomes such as increased risk of preterm birth; however, there are no prospective and well-controlled studies to fully understand the impact of HIV/HCV coinfection on pregnancy. Phase 1 studies suggest that DAAs are well-tolerated and effective during pregnancy. Only through large, prospective clinical trials will we be able to understand the interaction of HCV and HIV during pregnancy and to evaluate safety and efficacy of DAAs in this key population.
综述目的：在阿片类药物流行的背景下，生育年龄妇女的丙型肝炎病毒 (HCV) 感染率正在上升。感染 HIV/HCV 的孕妇可能面临更多不良妊娠和新生儿结局的风险，尽管这一关键人群的研究尚缺乏。
最新发现：直接作用抗病毒药物 (DAA) 的治疗已经改变了大多数 HCV 患者的临床治疗方法。然而，这些药物的临床试验排除了孕妇。最近的一项 I 期研究显示，ledipasvir-sofosbuvir 的安全性良好，具有出色的安全性；未发生围产期传播，100%持续病毒学应答，无安全性问题。妊娠是与医疗保健系统互动的最佳时期，因此是治疗 HCV 的理想时机。目前关于同时感染 HCV 和 HIV 的孕妇的观察性数据表明，早产风险增加等不良结局；然而，没有前瞻性和对照良好的研究来全面了解 HIV/HCV 合并感染对妊娠的影响。I 期研究表明，DAA 在妊娠期间耐受良好且有效。只有通过大型、前瞻性临床试验，我们才能了解 HCV 和 HIV 在妊娠期间的相互作用，并评估 DAA 在这一关键人群中的安全性和疗效。
