Guides

HCV and pregnancy

Importance of ART

ART is now recommended for all people living with HIV, including during pregnancy.

This is better for the mother’s health.

It also dramatically reduces the risk of transmitting both HIV and HCV to the baby.

Overall, the risk of HCV transmission during pregnancy is 3% to 5% if the mother is on ART.

It is 3 to 4 times higher if the mother is not on ART.

Importance of DAA treatment

HCV increases the risk of serious complications in pregnancy. This is why people who can become pregnant should have early access to HCV treatment.

The complications are for both the mother and baby.

For the mother, HCV increases the risk of gestational diabetes, liver damage (including intrahepatic cholestasis) and preeclampsia.

For the baby, HCV increases the risk for pre-term delivery, low birth weight and overall health (Apgar score), birth defects and infant mortality.

Ongoing research is addressing the safety and effectiveness of HCV DAAs during pregnancy.

Guidelines for people living with HIV and HCV who are pregnant recommend:

  • ART during pregnancy.
  • Counselling about signs and symptoms of liver toxicity. Liver enzyme tests are recommended one month after starting ART, and then every three months.
  • Treatment for HCV before pregnaancy or after delivery.
  • Screening for hepatitis A (HAV) and hepatitis B (HBV). This is because they also increase the risk of complications during pregnancy.
  • HAV and HBV vaccinations after the first trimester are recommended in all women. An extra vaccine dose may be needed if the CD4 cell count is below 300.
  • UK guidelines recommend vaginal delivery on ART, unless there are complications that need a C-section.

A friend who is co-infected just recently had a child and had to have a Caesarean section because of the HCV (her viral load was undetectable and CD4 count was high – so she could have delivered vaginally) but she was not able to because of HCV.

More info

i-Base Guide to HIV, Pregnancy and Women’s Health.
i-base.info/guides/pregnancy

BHIVA guidelines for the management of HIV infection in pregnant women.
www.bhiva.org

One thing that bothers me is that even in the HIV community there is discrimination against drug users… assumptions are often made by other HIV positive women regarding drug users. Especially if they want to have children … It is the same with some doctors … and sometimes they don’t pass the information that we need…

Last updated: 1 November 2024.