Evaluating Women's Preferences for Hepatitis C Treatment During Pregnancy.

There is a rising prevalence of hepatitis C (HCV) among women of child-bearing age nationally, which prompted a recommendation by national guidelines to screen all women for HCV during pregnancy. Women with HCV during pregnancy are at risk of perinatal transmission of HCV. Directly acting antiviral (DAA) therapy during pregnancy can potentially reduce the risk of perinatal transmission as well as cure women while they are engaged in antenatal care. However, data on the safety and efficacy of DAAs during pregnancy are limited. We aimed to evaluate the preferences of women with HCV regarding potential DAA treatment during pregnancy. We conducted a survey of women with a history of HCV followed in the University of California, San Francisco HCV clinic and in the Women's Interagency HIV Study (most of whom are coinfected with HIV) to determine their preferences for DAA treatment during pregnancy. A total of 141 women completed the survey. Sixty percent reported that they would be willing to take antepartum DAA therapy if it lowered the risk of perinatal transmission. Only 21% reported that they would agree to take DAA therapy during pregnancy for self-cure; 20% of women stated that they would not, yet indicated that they might change their minds if there were more human data available regarding use of DAAs during pregnancy. In multivariable analysis, having a previous history of taking DAAs and being of childbearing age at the time of the survey were associated with willingness to take DAA medication during pregnancy (odds ratios 4.29 and 4.11, respectively). Conclusion: These results point to the need for further investigation of the role of HCV therapy during pregnancy

Evaluating Women’s Preferences for Hepatitis C Treatment During Pregnancy

There is a rising prevalence of hepatitis C (HCV) among women of child-bearing age nationally, which prompted a recommendation by national guidelines to screen all women for HCV during pregnancy. Women with HCV during pregnancy are at risk of perinatal transmission of HCV. Directly acting antiviral (DAA) therapy during pregnancy can potentially reduce the risk of perinatal transmission as well as cure women while they are engaged in antenatal care. However, data on the safety and efficacy of DAAs during pregnancy are limited. We aimed to evaluate the preferences of women with HCV regarding potential DAA treatment during pregnancy. We conducted a survey of women with a history of HCV followed in the University of California, San Francisco HCV clinic and in the Women's Interagency HIV Study (most of whom are coinfected with HIV) to determine their preferences for DAA treatment during pregnancy. A total of 141 women completed the survey. Sixty percent reported that they would be willing to take antepartum DAA therapy if it lowered the risk of perinatal transmission. Only 21% reported that they would agree to take DAA therapy during pregnancy for self-cure; 20% of women stated that they would not, yet indicated that they might change their minds if there were more human data available regarding use of DAAs during pregnancy. In multivariable analysis, having a previous history of taking DAAs and being of childbearing age at the time of the survey were associated with willingness to take DAA medication during pregnancy (odds ratios 4.29 and 4.11, respectively). Conclusion: These results point to the need for further investigation of the role of HCV therapy during pregnancy

Cost-effectiveness of Antenatal Rescreening Among Pregnant Women for Hepatitis C in the United States.

To inform proposed changes in hepatitis C virus (HCV) screening guidelines in the United States, we assessed the cost-effectiveness of HCV antenatal rescreening for women without evidence of HCV during a prior pregnancy, using a previously published model. Universal HCV rescreening among pregnant women was cost-effective (incremental cost-effectiveness ratio, $6000 per quality-adjusted life-year) and should be recommended nationally

Intermittent fasting improves hepatic end points in nonalcoholic fatty liver disease: A systematic review and meta-analysis

Background and Aims:. Despite NAFLD being the most prevalent liver disease globally, currently there are no FDA-approved treatments, and weight loss through caloric restriction and enhanced physical activity is the recommended treatment strategy. Intermittent fasting (IF) has been proposed as an alternative strategy with additional cardiometabolic benefits. In this systematic review and meta-analysis, we evaluated the anthropometric, biochemical, and hepatic impacts of IF in patients with NAFLD. Methods:. MEDLINE, EMBASE, Cochrane Central, and conference abstracts were searched for IF interventions in adults with NAFLD until April 2, 2023. Meta-analysis with a random effects model was used to compare pre-intervention and post-intervention changes in anthropometric, biochemical, and hepatic end points in the IF intervention group with the control group. Publication bias was assessed using Egger’s test. Results:. Fourteen studies were included in the systematic review and ten in the meta-analysis (n = 840 participants, 44.64% male). Studies varied in modalities for NAFLD diagnosis, duration of IF (4–52 weeks), and type of IF (5:2 diet, modern alternate-day fasting, time-restricted eating, or religious fasting). Body weight, body mass index, and waist to hip ratio all significantly improved following fasting intervention (p< 0.05). Adults with NAFLD showed an improvement in serum alanine transaminase, aspartate aminotransferase, hepatic steatosis (controlled attenuation parameter measured by vibration-controlled transient elastography), and hepatic stiffness (measured by vibration-controlled transient elastography) after fasting intervention (p < 0.05). Conclusions:. There is limited, but moderate- to high-quality evidence to suggest that IF can improve hepatic end points and promote weight loss in adults with NAFLD. Larger randomized controlled studies with extended duration are needed to further validate our findings