How is hepatitis and HIV coinfection treated in pregnant women?

Updated: Apr 02, 2019
  • Author: Ashley T Peterson, MD; Chief Editor: Ronald M Ramus, MD  more...
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The current recommendation for treating women co-infected with HIV and HBV is to treat these women with tenofovir, lamivudine, telbivudine or emtricitabine. [32] All four have shown activity against HBV. A meta-analysis found that the use of lamivudine effectively prevents mother-to-child transmission, even in pregnant women who have a high degree of HBV infectiousness in late pregnancy. [33]

Women receiving treatment should be advised of the signs and symptoms of liver toxicity, and regular follow-up of transaminase levels is warranted. The infant should receive hepatitis B immunoglobulin and start the 3-dose series of hepatitis B vaccine within the first 12 hours of life. [18]

Pregnancy does not appear to alter the course of HCV infection; however, co-infection with HIV does appear to increase the risk of perinatal transmission of HCV. As such, a 3-drug antiviral combination is recommended regardless of the viral load. As with HBV co-infection, patients should be made aware of the signs and symptoms of liver toxicity, and transaminases should be assessed according to current guidelines.

As with HIV, prolonged rupture of membranes may increase the risk of perinatal HCV transmission; however, the data remain inconclusive regarding the use of cesarean section delivery to decrease the risk of transmission. As such, delivery recommendations are based on the HIV status. Infants can be evaluated by testing HCV RNA at 2 and 6 months of age or HCV antibody after 15 months of age. [18]

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