Management of hepatitis B and C in special population

Table 3 Hepatitis B and Hepatitis C in pregnancy

	HBV	HCV
MTCT	90% if HBeAg+; 10% if HBeAg-; Directly proportional to viral load	6%; Higher risk with concomitant HIV infection, higher viral load, IV drug abuse; Higher risk with PROM and CVS
Treatment	TDF is safe; Can be initiated in third trimester	DAAs are not approved; Treat prior to pregnancy or 6 mo postpartum
Effect on pregnancy outcome	None	Preterm birth, ICP
Effect of pregnancy on virus	None	None
Effect of postpartum (immune restoration) on virus	Risk of HBV flares	Higher chance of viral clearance
Timing of transmission	Intrapartum > intrauterine	Intrapartum > intrauterine
C-section for all	Not indicated	Not indicated
Breastfeeding	Not contraindicated	Not contraindicated
Prevention	Active and passive immunization to child prevents 90% of transmission; Failure is nearly 15% if the viral load in mother is > log6	None
Confirming the perinatal transmission	Persistence of HBsAg in newborn for > 6 mo	Anti-HCV positive at 18 mo of age HCV RNA positive after 2 mo on 2 different samples
Confirming the protection	Anti-HBs titers at 9 mo	Negative Anti-HCV at 18 mo

HBV: Hepatitis B virus; HCV: Hepatitis C virus; HIV: Human immunodeficiency virus; IV: Intravenous; MTCT: Mother-to-child transmission; PROM: Prolonged rupture of membranes; CVS: Chorionic villous sampling; Ag: Antigen; ICP: Intrahepatic cholestasis of pregnancy; C-section: Cesarean section.