Real-World Experience of Hepatitis C Treatment With Glecaprevir-Pibrentasvir During Pregnancy
Clinical Infectious Diseases
Authors: Madeline McCrary, Megan R Curtis, Jeannie C Kelly, Jessica Elrod-Gallegos, Patrick Kojima, Patricia Werner, Jennifer L Mullersman, Tracey Habrock-Bach, Michael J Durkin, Laura R Marks
This study reports the first real-world data on glecaprevir-pibrentasvir (GLE/PIB) treatment for hepatitis C virus (HCV) infection during pregnancy. While guidelines allow antenatal direct-acting antiviral treatment through shared decision-making, no prior clinical trial or real-world data existed specifically for GLE/PIB in pregnant patients, despite good outcomes previously reported for other regimens like sofosbuvir-velpatasvir and sofosbuvir-ledipasvir.
Between March 2024 and August 2025, 14 pregnant patients with HCV were prescribed GLE/PIB between 14 and 32 weeks' gestation (mean initiation at 25 weeks). Ten patients (71%) completed the eight-week course; the remaining four discontinued early, largely due to anxiety about fetal safety or loss of medication, with no reported safety concerns among them.
Among the 10 who completed treatment, all achieved undetectable HCV RNA by delivery, and all with available data achieved sustained virologic response at four weeks (SVR4) or better. No maternal liver enzyme abnormalities, new pregnancy complications (such as gestational diabetes or cholestasis), obstetric hemorrhage, or preterm deliveries occurred. Neonatal outcomes were similarly reassuring: no low birth weight, NICU admissions, stillbirths, or perinatal HCV transmissions were observed among the six infants screened.
The authors conclude that GLE/PIB appears effective, safe, and well tolerated when initiated in the second or third trimester, supporting current guideline recommendations. They highlight GLE/PIB's shorter treatment duration and fewer drug interactions as potential advantages over other regimens for pregnant populations facing time-limited insurance coverage and care windows.