Ontario study finds gaps in hepatitis C care during pregnancy and after birth
January 29, 2026
CATIE
- Researchers reviewed data on 16,888 pregnant people who were screened for hepatitis C
- Less than 10% who had active hepatitis C infection started treatment within five years of testing
- The researchers call for additional efforts to link people to care during pregnancy or after birth
Hepatitis C virus (HCV) infects the liver and causes inflammation in this vital organ. As chronic HCV infection sets in, healthy liver tissue is gradually replaced with scar tissue. Over time, the liver becomes increasingly dysfunctional, and a variety of problems ensue. Some people develop persistent fatigue. Later, they can develop internal bleeding, fluid buildup in the abdomen and serious abdominal infections. Eventually, difficulty thinking clearly and problems with memory occur. As the liver becomes increasingly unable to filter waste products from the blood, the skin and whites of the eyes gradually turn yellow (jaundice). The risk of liver cancer increases as the amount of scar tissue expands. If HCV is left undiagnosed and untreated, it can result in death.
HCV can be detected with blood tests. Furthermore, the health of the liver can be assessed with additional blood tests and a specialized ultrasound scan called Fibroscan.
Several powerful HCV treatments are available in pill form. These are called direct-acting antivirals (DAAs) and can be taken orally once daily. Two commonly used HCV treatments are as follows:
- Epclusa – a pill containing sofosbuvir + velpatasvir
- Maviret – a pill containing glecaprevir + pibrentasvir
These drugs are associated with high rates of cure—at least 95%—after a course of treatment (usually eight to 12 weeks, depending on the pill used). They are generally safe and well tolerated.
In Canada, DAAs first became available in 2014, with restrictions on who could access them through public subsidies. By 2018, these restrictions were lifted.
A shift in infections
Researchers in North America are finding that more people of childbearing age are getting chronic HCV infection. Increasingly, cases of chronic HCV infection are being diagnosed during pregnancy. As a result, leading public health agencies and medical associations have recommended universal HCV screening during pregnancy. However, preliminary research in Canada and the U.S. suggests that after a diagnosis during pregnancy, subsequent rates of HCV treatment appear to be low.
To find out more about the situation in Ontario when HCV is diagnosed during pregnancy, a team of scientists reviewed anonymized health-related information collected between 2003 and 2021. During this time, data were collected on 16,888 people who were pregnant and who tested positive for HCV with either an antibody test (which suggests exposure to HCV at some point in the past) or a viral RNA test (which uncovers active HCV infection). In total, there were 42,797 pregnancies (an average of about two per person over the course of the study).
On average, among participants the age at first conception was 27 and the age at the first HCV test was 30. In addition, 591 people in the study were diagnosed with hepatitis B virus coinfection and 368 were diagnosed with HIV coinfection.
Focus on HCV testing and treatment
As mentioned earlier, HCV RNA testing helps to uncover active HCV infection. During the study period, 14,538 people had RNA testing; of these, 7,457 people (51%) tested RNA positive.
The proportion of people with a positive RNA test who subsequently had HCV treatment was distributed as follows:
- one year after positive RNA test – 1%
- two years after positive RNA test – 3%
- five years after positive RNA test – 5%
Over the entire course of the study period, 3,861 people initiated treatment and about 31% of them were cured.
The researchers estimated that “348 infants may have been born with HCV” over the study period. This figure likely underestimated the true number of infants born with this virus.
Note that for most of the duration of the study, interferon-based therapy would have been the mainstay of HCV treatment. This needed to be injected weekly and was known to cause severe side effects. What’s more, sometimes interferon was used with another drug, ribavirin, which can harm the fetus. Therefore, low rates of treatment in the interferon era are understandable. However, in 2017, DAAs became more widely available, and interferon was no longer used to treat HCV.
According to the scientists, “[…] ongoing studies of DAAs in pregnancy have reported excellent safety and tolerability profiles, 100% [cure rates], and no vertical transmission.”
The study scientists found that after 2017 there were fewer delays in initiating HCV treatment. However, there was still an average delay of about two years for initiating treatment after a positive RNA test result. The researchers argued that one of the reasons for delays in care in the latter years of the study period may have been due to the disruptive impact of the COVID-19 pandemic on healthcare systems.
The researchers found that about 42% of pregnancies in the study resulted in abortions or early pregnancy loss. They stated that this finding “underscores the potential value of exploring approaches that promote engagement in HCV screening and counselling during management of unintended pregnancy, recognizing that this may be an emotionally difficult time and thus not optimal for everyone.” It also suggests an unmet need for contraception and pregnancy planning.
The scientists found that people who also had other chronic conditions (high blood pressure, substance use disorder) were more likely to initiate HCV treatment. They stated that this highlights “the value of strategies that integrate HCV screening and care for individuals already engaged in care services, especially [during and after pregnancy].”
Bear in mind
The study was not designed to explore why there was a delay between RNA testing and subsequent HCV treatment. As a result, the scientists can only mention that there were likely both patient-level and system-level issues that played a role in delayed initiation of treatment. These issues deserve to be studied that so that gaps in HCV care can be closed.
The present study’s findings highlight that much effort will be needed to help reduce the spread of HCV in Ontario and that attempts to link people to HCV care and treatment during and after pregnancy will need to be intensified.
—Sean R. Hosein
Resources
New Ontario hepatitis C elimination initiative – CATIE
Can Ontario eliminate hepatitis C by 2030? – CATIE webinar
Curing hepatitis C: What you need to know – CATIE brochure
Hepatitis C Basics– CATIE online course
Progress toward viral hepatitis elimination in Canada: 2025 report – Action Hepatitis Canada
REFERENCE:
Mendlowitz AB, Flemming JA, Kushner T, et al. Gaps in the hepatitis C prenatal and postpartum care cascade: Rationale for treatment in pregnancy. Clinical Infectious Diseases. 2026; in press.
From Canadian AIDS Treatment Information Exchange (CATIE).
This content was originally published by CATIE, Canada’s source for HIV and hepatitis C information.
Source: CATIE:
https://www.catie.ca/catie-news/ontario-study-finds-gaps-in-hepatitis-c-care-during-pregnancy-and-after-birth
For more information visit CATIE's Information Network at www.catie.ca
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