Table 1.

Research Gaps Related to HCV in Pregnancy and Vertical HCV Transmission

HCV in Pregnancy

When and how does HCV influence specific adverse outcomes in pregnancy such as gestational diabetes, preterm birth, and fetal growth restriction? What changes occur in the HCV-specific immune response during pregnancy: what triggers the surge in HCV-specific T cells? Can we predict the minority of women who will resolve their viremia postpartum? Can we use an abbreviated treatment protocol with new DAAs in this window to achieve high rates of viral clearance? What, if any, adverse effects do DAAs have on pregnancy and postpregnancy outcomes such as breastfeeding? Is there a role now for universal screening for HCV during pregnancy, both to increase awareness of infection and to increase those women that could be treated?

HCV Vertical Transmission What key host and viral factors allow HCV-infected women to transmit virus to their infants? When during pregnancy does transmission occur? Can single or multiple DAAs interrupt transmission?

HCV in Infancy When and how is the best way to reliably identify infected and uninfected infants in the first few months of life? Which infants will spontaneously resolve their viremia? Can we use DAAs in early infancy to prevent chronic infection from being established?

Abbreviations: DAA, direct-acting antiviral drugs; HCV, hepatitis C virus.