Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Apr 28, 2016; 8(12): 557-565
Published online Apr 28, 2016. doi: 10.4254/wjh.v8.i12.557
Antiviral therapy for hepatitis C: Has anything changed for pregnant/lactating women?
Anna Maria Spera, Tarek Kamal Eldin, Grazia Tosone, Raffaele Orlando
Anna Maria Spera, Tarek Kamal Eldin, Grazia Tosone, Raffaele Orlando, Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples Federico II, 80131 Napoli, Italy
Author contributions: Spera AM designed and wrote the review; Kamal Eldin T analyzed pharmacological and clinical data; Tosone G and Orlando R overview the manuscript.
Conflict-of-interest statement: All authors declare any conflicting interests (including but not limited to commercial, personal, political, intellectual or religious interests). In addition, reviewers have not potential conflicting interests related to any particular paper they maybe are asked to review.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Anna Maria Spera, MD, Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples Federico II, Via Sergio Pansini 5, 80131 Napoli, Italy.
Telephone: +39-08-17463082 Fax: +39-08-17493094
Received: November 24, 2015
Peer-review started: November 25, 2015
First decision: December 28, 2015
Revised: February 9, 2016
Accepted: March 22, 2016
Article in press: March 23, 2016
Published online: April 28, 2016

Hepatitis C virus (HCV) affects about 3% of the world’s population, with the highest prevalence in individuals under 40. The prevalence in pregnant women varies with geographical distribution (highest in developing countries). Prevalence also increases in sub-populations of women at high risk for blood-transmitted infections. HCV infection in pregnancy represents a non-negligible problem. However, most of the past antiviral regimens cannot be routinely offered to pregnant or breastfeeding women because of their side effects. We briefly reviewed the issue of treatment of HCV infection in pregnant/breastfeeding women focusing on the effects of the new direct-acting antivirals on fertility, pregnancy and lactation in animal studies and on the potential risk for humans based on the pharmacokinetic properties of each drug. Currently, all new therapy regimens are contraindicated in this setting because of lack of sufficient safety information and adequate measures of contraception are still routinely recommended for female patients of childbearing potential.

Keywords: Hepatitis C virus infection, Breastfeeding woman, Antiviral therapy, Pregnancy category, Direct-acting antivirals

Core tip: Until recently, the only drugs available for the treatment of hepatitis C virus infection had a well-documented teratogenic effect limiting their use in childbearing women. Recently, new generation drugs, designated the direct-acting antivirals have been approved. There are no studies available describing their effects on pregnant and lactating women. We here will try to analyze their pharmacokinetic properties and data from animal studies to try to predict their potential use pregnancy.