Transmission of HCV to a baby during pregnancy
ART is now recommended for all HIV positive people, including during pregnancy.
As well as being better for the mother’s health, it dramatically reduces the risk of transmitting both HIV and HCV to the baby.
Overall, this risk of HCV transmission during pregnancy is 3% to 5%, but it is 3 to 4 times higher if the mother is HIV positive and not on ART.
Hopefully, new HCV DAAs will be safe and effective during pregnancy, but more information is needed before they can be recommended. The old HCV drugs (pegylated interferon and ribavirin) cannot be used during pregnancy, because ribavirin causes birth defects, and interferon can cause brain and nerve damage in infants.
Women of childbearing age who have HIV/HCV coinfection should therefore have early access to HCV treatment.
HCV increases the risk of gestational diabetes, and liver damage can worsen during pregnancy. HCV also increases the risk for pre-term delivery, low birth weight and overall health (Apgar score), birth defects and infant mortality.
Guidelines for HIV positive pregnant women also recommend:
- Screening for HCV during each pregnancy.
- Screening for hepatitis A (HAV) and hepatitis B (HBV). This is because of an increased risk of complications during pregnancy from these infections. Vaccination against HAV and HBV is recommended in all non-immune HCV coinfected women after the first trimester. An additional dose may be needed if the CD4 cell count is below 300.
- ART is recommended during pregnancy (as for HIV positive women without HCV).
- Counselling women with HIV and HCV coinfection who are receiving ART about signs and symptoms of liver toxicity. Liver enzyme tests are recommended one month after starting ART, and then every three months.
- The mode of delivery in coinfection should be based on standard obstetric and HIV-related indications.
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.
For more information:
i-Base Guide to HIV, Pregnancy and Women’s Health (latest edition).
BHIVA guidelines for the management of HIV infection in pregnant women (2012, 2014 interim update).
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: 17 August 2017.