Evidence for Implementation: HIV/HCV Coinfection and Pregnancy

Curtis, Megan; Chappell, Catherine A.

doi:10.1007/s11904-022-00643-9

Cited by 5 publications

(2 citation statements)

References 64 publications

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“…Despite the fact that none of the aforementioned drugs are deemed safe for use during pregnancy and no clinical trials have been performed in this patient population group, we did find reports of their use during pregnancy. Velpatasvir, ledipasvir, paritaprevir, and sofosbuvir all have been previously used during pregnancy (AbdAllah et al 2021;Zeng et al 2022;Curtis and Chappell 2023;Kislovskiy et al 2021;Chappell et al 2020).…”

Section: Discussionmentioning

confidence: 99%

HCV Antiviral Drugs Have the Potential to Adversely Perturb the Fetal-Maternal Communication Axis through Inhibition of CYP3A7 DHEA-S Oxidation

Work,

Hackett,

Lampe

2024

Drug Metab Dispos

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The hepatitis C virus (HCV) poses a great risk to pregnant people and their developing fetus, yet no HCV antiviral treatment guidelines have been established. While there has been a substantial increase in the development of HCV antivirals, the effect they have on the developing fetus remains poorly defined. Many of these drugs are metabolized through the cytochrome P450 CYP3A pathway, which is mediated by CYP3A7 in the fetus and developing infant. In this study, we sought to investigate the effect HCV antivirals have on CYP3A7 metabolism, as this CYP enzyme plays a vital role in proper fetal and neonatal development. Of the thirteen HCV antivirals we investigated, eight (~62%) inhibited CYP3A7 metabolic activity by 50% or more at a concentration of 20 µM. Furthermore, paritaprevir, asunaprevir, simeprevir, danoprevir, and glecaprevir all had observed half-maximal inhibitory concentrations between the range of 10-20 µM, which is physiologically relevant in comparison to the K m of DHEA-S oxidation (reported to be between 5 to 20 µM). We also discovered that paritaprevir is a timedependent inhibitor of CYP3A7, which shifts the IC 50 ~2-fold from 11 µM to 5 µM. Upon further characterization, paritaprevir inactivates DHEA-S metabolism by CYP3A7, with K I and K inact values of 4.66 µM and 0.00954 min -1 , respectively. Depending on treatment plan and off-label drug use, HCV treatment could adversely affect the fetal-maternal communication axis by blocking fetal CYP3A7 metabolism of important endogenous hormones.

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Section: Discussionmentioning

confidence: 99%

HCV Antiviral Drugs Have the Potential to Adversely Perturb the Fetal-Maternal Communication Axis through Inhibition of CYP3A7 DHEA-S Oxidation

Work,

Hackett,

Lampe

2024

Drug Metab Dispos

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“…However, these therapies are not yet well studied in pregnancy, and their use is not recommended during pregnancy (38). As research progresses and therapies are tested in pregnancy, more wide-scale therapy may be available, with the possibility of decreasing the risk of perinatal transmission (39).…”

Section: Hepatitis C Screeningmentioning

confidence: 99%

Viral Hepatitis in Pregnancy

Silva

Schiff²

2023

Obstetrics &Amp; Gynecology

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PURPOSE: The purpose of this document is to describe the specific types of viral hepatitis, their implications during pregnancy, the risk of perinatal transmission, and issues related to both treatment and prevention of infection. TARGET POPULATION: Pregnant or postpartum women and individuals who screen positive for viral hepatitis infection. The onset of these conditions may have predated the perinatal period or may have occurred for the first time in pregnancy or the first year postpartum. METHODS: This guideline was developed using an a priori protocol in conjunction with a writing team consisting of one specialist in obstetrics and gynecology appointed by the ACOG Committee on Clinical Practice Guidelines–Obstetrics and one external subject matter expert. ACOG medical librarians completed a comprehensive literature search for primary literature within Cochrane Library, Cochrane Collaboration Registry of Controlled Trials, EMBASE, PubMed, and MEDLINE. Studies that moved forward to the full-text screening stage were assessed by two authors from the writing team based on standardized inclusion and exclusion criteria. Included studies underwent quality assessment, and a modified GRADE (Grading of Recommendations Assessment, Development, and Evaluation) evidence-to-decision framework was applied to interpret and translate the evidence into recommendation statements. RECOMMENDATIONS: This Clinical Practice Guideline includes recommendations on hepatitis B virus and hepatitis C virus screening in pregnancy; prepregnancy, antepartum, intrapartum, and postpartum management for patients with hepatitis B virus infection or hepatitis C virus infection; management of accidental and occupational exposure to hepatitis B virus or hepatitis C virus in pregnant health care workers; and hepatitis A virus and hepatitis B virus vaccination in pregnancy. Recommendations are classified by strength and evidence quality. Ungraded Good Practice Points are included to provide guidance when a formal recommendation could not be made because of inadequate or nonexistent evidence.

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Hepatitis co-infection in paediatric HIV: progressing treatment and prevention

Rubino,

Stinco,

Indolfi

2024

Current Opinion in HIV and AIDS

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Purpose of review To analyse the main evidence and recommendations for the management of hepatitis co-infection in children living with HIV. Recent findings We analysed available data pertaining to the natural history of liver disease and treatment of co-infected children. Summary Viral hepatitis co-infection in people living with HIV (PLHIV) is a global problem owing to the shared routes of transmission, particularly in areas of high endemicity for the three viruses. Viral hepatitis co-infection can accelerate liver disease progression and increase morbidity and mortality, even in patients on suppressive antiretroviral treatment (ART). Viral hepatitis should be routinely screened in PLHIV and, once diagnosed with viral hepatitis, PLHIV should be closely monitored for liver disease progression and complications. Children living with HIV-HBV co-infection should be treated with ART containing agents which are active against both viruses. Children living with HIV-HCV co-infection should receive directly acting antivirals (DAA) to eradicate HCV infection. Prevention measures to reduce vertical and horizontal transmission of HBV and HCV (anti-HBV vaccination and immunoglobulins, anti-HBV treatment in pregnancy, anti-HCV DAAs in people of childbearing age, avoiding blood contact, sexual barrier precautions) should be adopted and encouraged, particularly in high endemicity countries.

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Evidence for Implementation: HIV/HCV Coinfection and Pregnancy

Cited by 5 publications

References 64 publications

HCV Antiviral Drugs Have the Potential to Adversely Perturb the Fetal-Maternal Communication Axis through Inhibition of CYP3A7 DHEA-S Oxidation

HCV Antiviral Drugs Have the Potential to Adversely Perturb the Fetal-Maternal Communication Axis through Inhibition of CYP3A7 DHEA-S Oxidation

Viral Hepatitis in Pregnancy

Hepatitis co-infection in paediatric HIV: progressing treatment and prevention

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