Global epidemiology, natural history, maternal-to-child transmission, and treatment with DAA of pregnant women with HCV: a systematic review and meta-analysis.

Autor: Quek JWE; Yong Loo Lin School of Medicine, National University of Singapore, Singapore., Loo JH; Department of Gastroenterology & Hepatology, Changi General Hospital, Singapore., Lim EQ; Duke-NUS Medical School, Singapore., Chung AH; Duke-NUS Medical School, Singapore., Othman ABB; Duke-NUS Medical School, Singapore., Tan JJ; Yong Loo Lin School of Medicine, National University of Singapore, Singapore., Barnett S; Division of Gastroenterology & Hepatology, Stanford University Medical Centre, Palo Alto, CA, USA., Nguyen MH; Division of Gastroenterology & Hepatology, Stanford University Medical Centre, Palo Alto, CA, USA.; Department of Epidemiology and Population Health, Stanford University Medical Centre, Palo Alto, CA, USA., Wong YJ; Yong Loo Lin School of Medicine, National University of Singapore, Singapore.; Department of Gastroenterology & Hepatology, Changi General Hospital, Singapore.; Duke-NUS Medical School, Singapore.; Division of Gastroenterology & Hepatology, University of Alberta, Edmonton, Canada.
Jazyk: angličtina
Zdroj: EClinicalMedicine [EClinicalMedicine] 2024 Jul 13; Vol. 74, pp. 102727. Date of Electronic Publication: 2024 Jul 13 (Print Publication: 2024).
DOI: 10.1016/j.eclinm.2024.102727
Abstrakt: Background: Pregnant women with hepatitis C virus (HCV) infection represent a special population in which treatment access remains limited despite its increasing prevalence. A reliable estimate of the burden and clinical outcomes of pregnant women with HCV infection is crucial for HCV elimination. We aimed to determine the prevalence, maternal-to-child transmission (MTCT), maternal and fetal complication rates, and direct acting antivirals (DAA) treatment outcomes of chronic HCV infection in pregnant women.
Methods: We searched PubMed, EMBASE, Scopus, Web of Science from inception until March 1, 2024, for studies reporting on the prevalence, MTCT, complications of HCV infection, and treatment outcomes of DAA in pregnant women. Study quality was assessed using the Newcastle-Ottawa Scale. We performed subgroup analysis based on 9 variables to explore the source of heterogeneity in HCV prevalence. The PROSPERO registration number is CRD42024500023.
Findings: From a total of 311,905,738 pregnant women from 333 studies, the pooled global seroprevalence of HCV in pregnant women was 2.6% (95% CI: 2.0-3.2, I 2  = 100%) which increased in patients with intravenous drug use and HIV. Majority of the HCV cases in pregnant women (75%) are diagnosed through universal screening. The pooled MTCT rate was 9.0% (95% CI: 6.6-11.7, I 2  = 79%), which was higher with HIV co-infection (OR: 3.1, 95% CI: 2.1-4.6, I 2  = 10%), but was not influenced by the mode of delivery or breastfeeding. Pregnant women with HCV infection had more maternal complications, including intrahepatic cholestasis, preterm delivery, and antepartum hemorrhage. Neonates of mothers with HCV had higher odds of being small for gestational age. The pooled rate of sustained virologic response (SVR12) among the 74 women treated with DAA during pregnancy was 98.4%, with no serious adverse events reported.
Interpretation: HCV prevalence in pregnant women varies by geographic region and patient population, while MTCT occurs in almost one in ten viremic mothers. The incidence of both maternal and neonatal complications is significantly higher in patients with HCV infection. Limited data suggest that DAA are safe in pregnant women with HCV infection.
Funding: None.
Competing Interests: MHN: Research support: Pfizer, Enanta, Gilead, Exact Sciences, Vir Biotech, Helio Health, National Cancer Institute, Glycotest, B.K. Kee Foundation; Consulting and/or Advisory Board: Intercept, Exact Science, Gilead, GSK, Eli Lilly, Laboratory of Advanced Medicine, Janssen; WYJ: Invited speaker: Gilead. All other authors declare no competing interests.
(© 2024 The Author(s).)
Databáze: MEDLINE
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