Hepatitis C Increases Preterm Delivery Risk in HIV-Infected Women

Hepatitis C virus (HCV) coinfection increases the risk of preterm birth in women with HIV four-fold to those with lone HIV, according to a new study.

Justyna Kowalska, MD, PhD, of the Hospital for Infectious Diseases and the Medical University of Warsaw, told MD Magazine® the study aimed to give greater clarity to the roles of HCV and HIV in the pregnancies of coinfected women.

“It is well recognized in [the] mono-HCV infected population that HCV replication affects intrauterine fetus growth and can also lead to preterm delivery,” she said.

HIV itself is not associated with preterm delivery, though antiretroviral therapy is. “However, most large HIV studies do not include HCV replication as a potential risk factor,” Kowalska said.

The HIV outpatient clinic at Kowalska’s hospital, however, provided a large enough patient population to study the issue of HIV/HCV coinfection more closely. The researchers looked at data from 2006 to 2017, finding 187 pregnancies.

After excluding pregnancies that ended in abortions and pregnancies where the outcome or combination ART status was unknown, they were left with 159 applicable pregnancies. Of those, 19 (11.9%) concluded with a preterm delivery. Among the women included in the study, 27% had chronic HCV coinfection.

About half (52%) of patients were taking combination ART at the time they became pregnant, and 1 in 5 had a detectable viral load when they went into labor. Kowalska noted that initiating ART prior to pregnancy has been associated with a higher risk of preterm birth, though she said that finding was not replicated in their study, likely due to the small sample size.

The scientists analyzed the data to determine individual causes, after which the only factor associated with increased odds of a preterm birth was HCV coinfection. Kowalska said larger studies are needed to draw broad conclusions, but she said one key conclusion from her study is that HCV needs to be considered as a factor whenever researchers study preterm births.

In the meantime, Kowalska urged physicians to take HCV very seriously in pregnant patients.

“All women with confirmed HCV (irrespective of HIV status) should be informed about the risk it brings (risk of transmission to both baby and sexual partners, and risk of unfavorable pregnancy outcome),” she said. “They should be informed about HCV treatment options and if they plan pregnancy they should be prioritized in HCV treatment programs.”

Kowalska noted that new guidelines from the European AIDS Clinical Society published last month align with the findings of her study.

Those guidelines state that in women of childbearing age, HCV treatment should be initiated “prior to conception because of the lack of safety data in pregnancy and to reduce the risk of [mother-to-child transmission] of HCV.”

The study, “HCV co-infection is a strong risk factor for preterm birth among HIV-positive women on cART: data from HIV Out-Patient Clinic in Warsaw,” was presented at the 2018 International Congress on Drug Therapy in HIV Infection.