Considering direct-acting antivirals to cure hepatitis C virus during pregnancy: is this the last treatment frontier?

Hepatitis C (HCV) is on the rise among women of childbearing age as well as young children in the USA, suggesting increasing mother-to-child transmission (MTCT) of the virus.1 Epidemiologic data demonstrates that HCV is now a bimodal disease. In addition to the originally identified birth cohort (1945–1965), a second spike in prevalence is recognized in individuals between the ages of 20 years and 35 years, driven primarily by the concurrent rise in injectable opioid abuse, as well as ongoing challenges to HCV prevention and access to HCV direct-acting antiviral (DAA) treatment.2,3 This younger demographic includes women of reproductive age in the USA where the number of exposed women doubled between 2006 and 2014. As a result, rates of HCV among pregnant women at delivery increased 89% between 2009 and 2014. HCV infection in infants and children has also increased, presumably as a result of MTCT of the virus.4,