Physician perspectives on hepatitis C treatment for women of childbearing age and during pregnancy: results from a global multispecialty survey
Recommended Citation
Kushner T, Buti M, Papatheodoridis G, El-Kassas M, Yilmaz Y, TakahashI H, Eguchi Y, Roberts S, Chan W, Yu M, Ocama P, Khaderi S, Wungjiranirun M, Jacobson I, Gordon SC, Olivé AN, Ward J, Gupta N, Hiebert L, Reynoso S, Racila A, Henry L, Stepanova M, Younossi Z. Physician perspectives on hepatitis C treatment for women of childbearing age and during pregnancy: results from a global multispecialty survey. J Hepatol 2025; 82:S710-S711.
Document Type
Conference Proceeding
Publication Date
5-1-2025
Publication Title
J Hepatol
Abstract
Background and aims: There is limited guidance regarding hepatitis C virus (HCV) treatment in pregnancy but emerging data suggests direct acting antiviral (DAA) therapy for these patients is safe and effective. We performed a global survey among gastro-hepatologists (GI-hep), infectious disease (ID) specialists, obstetricians (ob-gyn), and primary care physicians (PCPs) to explore current perspectives on HCV treatment in pregnancy. Method: A 39-item survey was designed by members of The Global Liver Council (GLC) through an iterative process including revisions by experts at GLC, American College of Obstetricians and Gynecologists (ACOG), and the Coalition for Global Hepatitis Elimination (CGHE). The survey was distributed electronically starting in 9 2024 through GLC, CGHE, ACOG and institutional provider networks. Multivariable regression was performed to evaluate predictors of willingness to treat HCV in pregnancy. Results: To date, 442 surveys have been completed from 49 countries (53% GI-hep, 29% PCPs, 18% Ob-Gyns, 10% ID). 30% of respondents reported that ≥ 50% of their patients were women of childbearing age. Regarding HCV knowledge, 66% of providers self-assessed as adequate or superior (89% GI-hep, 49% PCPs, 26% Ob-Gyn, p < 0.01), and 63% reported being comfortable treating HCV (88% GI-hep, 42% PCP, 21% Ob-Gyn, p < 0.01). Majority (80%) reported discussing pregnancy plans with HCV-positive women; 77% screen for pregnancy prior to initiation of DAAs. Only 12% reported treating a pregnant woman with DAAs (8% GI-hep, 13% PCP, 22% Ob-gyn, p < 0.01), and 21% would consider treating these patients (14% GI-hep, 24% PCP, 37% Ob-Gyn, p < 0.01). The main reasons for not considering DAAs in pregnancy were lack of safety data for DAAs in pregnancy (60% of responders) and adequate guidelines (56%). Majority of Ob Gyns (57%) would refer to specialty care for HCV treatment during pregnancy. If an individual became pregnant while on DAAs, 29% would continue, 31% would stop, 23% would refer to another specialist, and 13% did not know. Across regions of the world, the highest acceptance of DAA use in pregnancy was in North America (45% vs. < 0.01). In multivariate analysis, the only predictor of a greater willingness to treat HCV in pregnancy was having ≥ 10% of practice that are injection drug use population (adjusted OR (95% CI) = 2.5 (1.5–4.2)) while GI-hep specialty was associated with a lower willingness (OR = 0.4 (0.2–0.7)). Conclusion: Despite adequate levels of HCV knowledge, few providers have experience with HCV treatment in pregnancy or would consider it. Ob-gyns are more in support of HCV treatment in pregnancy, but less comfortable treating themselves, which can lead to referral to specialists who are reluctant to treat. Further availability of safety evidence and inclusion of specific recommendations in guidelines could increase uptake of DAAs for pregnant individuals.
Volume
82
First Page
S710
Last Page
S711
