Female Sex, Recent Pregnancy Linked to Poor HCV Treatment Rates in Opioid Use Disorder

Among people with hepatitis C virus (HCV) infection entering opioid use disorder (OUD) treatment in the United States, female sex and recent pregnancy are independent risk factors for reduced likelihood of direct-acting antiviral (DAA) prescription, according to findings from a recent study.1

Leveraging data from the Merative MarketScan Commercial and Multi-State Medicaid Databases, the study found significant differences in DAA prescription between men and women, most starkly in women with recent pregnancy compared to men and women without recent pregnancy. Given findings illustrating challenges in postpartum linkage to HCV care, investigators suggest pregnancy could be a window of opportunity for HCV treatment that merits further research.1

“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,” said first study author Caroline Cary, a third-year medical student at WashU Medicine.2 “It’s imperative to make hepatitis C care more readily accessible to new moms considering the long-term consequences of the condition.”

According to the World Health Organization, an estimated 50 million people have chronic HCV infection, with about 1 million new infections occurring per year. HCV is commonly transmitted via injecting drug use through the sharing of injection equipment, which has become especially pertinent during the ongoing opioid epidemic, as well as from an infected mother to her baby.3

Notably, postpartum linkage to care has been poor, with one study finding just 6% of women with Medicaid insurance with OUD and HCV infection received DAAs within 6 months of delivery.4

To contextualize emerging data and evaluate the association between pregnancy in the past year and prescription of DAAs, investigators conducted a retrospective cohort study of individuals with HCV infection entering OUD treatment using the Merative MarketScan Commercial and Multi-State Medicaid Databases. The outcome variable of interest was the prescription of DAAs after the initiation of OUD treatment, with HCV treatment initiation defined as receiving a first-time prescription of ≥ 1 DAA.1

The exposure variables of interest were sex and recent pregnancy status. To identify women with a recent pregnancy, investigators evaluated the previous 360 days for pregnancy status as > 1 claim for any pregnancy-related condition regardless of whether it culminated in live birth.1

In total, the analysis included 22,347 episodes spanning 19,668 people with HCV infection who were initiating OUD treatment. This included 8864 men (45.1%), 7567 women without recent pregnancy (38.5%), and 3237 women with recent pregnancy (16.5%). Most of the sample (90.8%) was enrolled in Medicaid, among whom the majority were non-Hispanic White (89.2%).1

A total of 7332 individuals (37.3%) were prescribed DAAs within 1 year of OUD treatment. Investigators noted men were the most likely to be prescribed DAAs (40.6%), followed by women without recent pregnancy (35.7%) and women with recent pregnancy (31.8%).1

In adjusted analyses, men and women without recent pregnancy had greater rates of HCV treatment compared with women with recent pregnancy (adjusted hazard ratio [aHR], 1.18; 95% CI, 1.13–1.24; and aHR, 1.09; 95% CI, 1.04–1.13, respectively).1

“In summary, our findings identify recent pregnancy as a barrier to HCV treatment and possible driver in observed sex-based disparities. Further research must be done to determine optimal care delivery strategies for pregnant and postpartum individuals,” investigators concluded.1 “Given the challenges described regarding postpartum linkage to HCV care, we suggest that pregnancy could be a window of opportunity for HCV treatment that must be further studied.”

References

1. Cary CB, McCrary ML, Marks LR, et al. Association Between Sex and Recent Pregnancy and Hepatitis C Virus Treatment in People With Opioid Use Disorder. O&G Open. doi:10.1097/og9.0000000000000096

2. Washington University in St. Louis. Hepatitis C Treatment Is Not Reaching Some at-Risk Populations. Newswise. July 14, 2025. Accessed July 15, 2025. https://www.newswise.com/articles/hepatitis-c-treatment-is-not-reaching-some-at-risk-populations/?sc=mwhr&xy=10023887

3. World Health Organization. Hepatitis C. April 9, 2024. Accessed July 15, 2025. https://www.who.int/news-room/fact-sheets/detail/hepatitis-c

4. Jarlenski M, Chen Q, Ahrens KA, et al. Postpartum follow-up care for pregnant persons with opioid use disorder and hepatitis C virus infection. Obstet Gynecol 2022;139:916–8. doi:10.1097/AOG.0000000000004760