Hepatitis C treatment gaps persist in postpartum women, children

Hepatitis C treatment gaps persist in postpartum women, children | Image Credit: © Dr_Microbe – stock.adobe.com.

Two studies conducted by researchers at Washington University School of Medicine in St. Louis highlight gaps in hepatitis C virus (HCV) care among children and recently pregnant women, 2 populations vulnerable to long-term adverse liver outcomes. The findings, published in Pediatrics and Obstetrics & Gynecology Open, underscore how race, age, geography, and peripartum status affect access to direct-acting antiviral (DAA) therapy, despite the availability of effective treatment.^1-3

“We have treatments for hepatitis C where it’s just 2 or 3 months of pills and then over 95% of people are cured,” said Megan Curtis, MD, assistant professor in the Division of Infectious Diseases at WashU Medicine, who led both studies. “But we are still having difficulties in getting the treatments to the populations that need them the most. These kinds of studies can help us identify where those barriers are.”

Pediatric treatment disparities

In the study published in Pediatrics, Curtis and colleagues analyzed data from the TriNetX Research Network to characterize the HCV care cascade among 928 U.S. children diagnosed with HCV between 2000 and 2022. Despite clinical guidelines recommending DAA treatment for children aged 3 years and older, only 32.0% of children were linked to HCV care, and just 12.0% received antiviral therapy.²

Children born between 2014 and 2018 had the highest rates of linkage to care (P = .008), and those diagnosed before age 3 were more likely to be linked to care (P = .03) but less likely to receive treatment (P = .01) compared to older children. The decline in DAA prescriptions after 2020 may reflect pandemic-related disruptions or the delayed rollout of pediatric formulations.

The study identified significant racial and regional disparities. Hispanic/Latinx children had more than twice the odds of linkage to care compared to Black children (odds ratio [OR], 2.20; 95% CI, 1.05–4.59), while White children had over triple the odds (OR, 3.44; 95% CI, 1.89–6.28). Geographic differences were also notable, with children in the South least likely to be linked to care.

“Parents might also delay because of the difficulty of administering a medicine to a young child,” Curtis explained. “And clinicians may delay treatment because some children who have hepatitis C will spontaneously clear it on their own. However, this isn’t always the case.”

Peripartum barriers to care

In a second study published in Obstetrics & Gynecology Open, Curtis and colleagues, including co-senior author Kevin Xu, MD, examined DAA uptake in 19,668 individuals with HCV entering opioid use disorder (OUD) treatment between 2015 and 2019. Using the Merative MarketScan database, the authors found that recently pregnant women were significantly less likely to receive HCV treatment compared with both men and nonpregnant women.³

Among all individuals initiating OUD treatment, 37.3% received DAAs within 1 year. However, only 31.8% of recently pregnant women received treatment, compared with 35.7% of nonpregnant women and 40.6% of men. Adjusted analyses confirmed that women with recent pregnancy were 18% less likely than men (adjusted hazard ratio [aHR], 1.18; 95% CI, 1.13–1.24) and 9% less likely than nonpregnant women (aHR, 1.09; 95% CI, 1.04–1.13) to receive antiviral treatment.

Caroline Cary, the study’s first author and a third-year medical student, noted that postpartum priorities may hinder access to care. “People with hepatitis C are often asymptomatic for years after being exposed, so if you are young, otherwise healthy, and have a new baby, getting prompt treatment may not be a top priority, especially if it is challenging to access,” she said.

Implications for practice

The findings suggest that postpartum and pediatric patients may be overlooked in HCV elimination strategies, despite treatment guidelines recommending universal screening and timely therapy. As Curtis stated, “We need to come up with better strategies for addressing hepatitis C. We have all the tools to eliminate it. We have medications that can treat it. We know the people who need to get it. We just need to step up the availability and the awareness. We could be done with hepatitis C in a generation.”

Together, these studies support targeted interventions to improve linkage to care and DAA uptake among children and postpartum women, particularly in minoritized and underserved populations.

References:

1. WashU Medicine. Hepatitis C treatment is not reaching some at-risk populations. EurekAlert. July 11, 2025. Accessed July 16, 2025. https://www.eurekalert.org/news-releases/1090972
2. Curtis MR, Munroe S, Biondi BE, Ciaranello AL, Linas BP, Epstein RL. Disparities in Linkage to Care Among Children With Hepatitis C Virus in the United States. PEDIATRICS. Published online April 18, 2025. doi:https://doi.org/10.1542/peds.2024-068565
3. Cary CB, McCrary LM, Marks LR, et al. Association Between Sex and Recent Pregnancy and Hepatitis C Virus Treatment in People With Opioid Use Disorder. O&G Open. 2025;2(4):e096. doi: