The Reproductive Care of Women Living With Hepatitis C Infection
VII. Therapeutics
A. General
HCV-infected women should be encouraged to have a normal well
balanced diet and to restrict alcohol consumption to less than two
units per day. Support or treatment programmes may be offered to
that effect.
B. Specific Anti-Viral Therapy
\ Dual ribavirin and interferon therapy is the current standard
treatment, and may give a superior response rate to interferon alone.
A sustained response with long-term viral clearance is obtained
in 30 to 40 percent of cases. Anti-viral treatment is not currently
advocated in pregnancy and there is no evidence that interferon
may affect vertical transmission rates.
Alpha interferon 2b three times a week has been shown to produce
a five to 20 percent viral clearance. No teratogenicity or reproductive
toxicity has been reported in human pregnancy despite an abortifacient
effect in rhesus monkeys at 90 to 360 times the human dose. There
may be a case for its use in pregnant women with advanced liver
disease as part of a wellplanned clinical research protocol. Inadvertent
exposure in early pregnancy is probably not an issue.
Ribavirin is teratogenic and embryolethal in almost all species
and is contraindicated for use in pregnant women. Inadvertent exposure
may be an indication for termination although there is no actual
data on which to draw at present. Women considering ribavirin therapy
should be advised of the need for effective contraception.
C. Maternal Immunization
As infection with HCV carries a significant risk of progressive
liver disease, every effort should be made to avoid further conditions
with the potential for liver damage. Serious consideration should
be given to immunizing pregnant women against both hepatitis A and
B. Superinfection with hepatitis A poses a serious threat to patients
with chronic HCV. In a series published in 1998, 41 percent of superinfected
patients developed fulminant liver failure, and all but one died.113
A combined vaccine is also available. For further information regarding
these immunizations, please refer to the Canadian Immunization Guide114 or the Health Canada websites (see Sections XII.A and B: On-line
information sites).
D. Principles of Prescribing in HCV-Infected Women
In the absence of cirrhosis, patients with chronic HCV infection
should not be treated differently from the general population. Even
in cases with cirrhosis, drug metabolism will be normal while liver
function is maintained. Hepatic function should be assessed biochemically
with INR, albumin, and bilirubin, and clinically with the presence
or absence of ascites, encephalopathy, and portal hypertension.
In the presence of an abnormality in one or more of these parameters,
prescription of medication should be carefully considered in conjunction
with a hepatologist.
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