Hepatitis C Virus Infection in Pregnancy and Children: Its Implications and Treatment Considerations with Directly Acting Antivirals: A Review

Hepatitis C virus infection is a global health problem affecting >71 million people worldwide with chronic hepatitis C, 40% reproductive age group, and 8% pregnant women. Intravenous drug abuse, multi-transfusions are major risk factors in adults, while vertical transmission in pediatric population. It presents as a chronic liver disease, has higher risk of liver cirrhosis and even progression to hepatocellular carcinoma. Proper screening of high-risk populations including pregnancy is recommended. All diagnosed chronic hepatitis C cases should be treated with directly acting antivirals including pre-conception. This would reduce the disease burden, vertical transmission, and disability associated. However, no directly acting antivirals regimens recommendation till date due to lack of evidence on adverse fetal outcomes and are concerned about the pharmacokinetic effect regarding physiological changes during pregnancy. Therefore, in this review, we have tried to explore the possible use of directly acting antivirals regimens and their safety issues during pregnancy, and possible consideration of few pan-genotypic regimens in the late second and early third trimester. This would not only prevent vertical transmission and decrease disease burden but also help to meet the World Health Organisation 2030 target of hepatitis C virus elimination as a major public health problem.