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As the opioid crisis has escalated in the United States, the incidence of hepatitis C has risen as well. Hepatitis C is a viral pathogen transmitted through the blood that harms the liver. It is primarily spread through the sharing of needles or other injection apparatus and can also be transmitted from mother to child during pregnancy or delivery. Fortunately, it can be effectively and safely treated with direct-acting antiviral medications that are authorized for use in both adults and children.
Two recent investigations by scholars at Washington University School of Medicine in St. Louis indicate that two at-risk demographics — children and recently postpartum women — encounter inequalities in accessing treatment for hepatitis C infection. Without intervention, these populations are at heightened risk for enduring negative health effects such as cirrhosis, liver cancer, and mortality.
One investigation, published in Pediatrics in conjunction with researchers at Massachusetts General Hospital, discovered that few children diagnosed with hepatitis C were referred for treatment. The research also illuminated significant disparities in whether these patients received care based on a child’s ethnicity, geographic area, and age. A second study, spearheaded by WashU Medicine researchers and released on July 10 in Obstetrics & Gynecology Open, demonstrated that recently postpartum women infected with hepatitis C were significantly less likely to obtain treatment than men or women who had not recently given birth.
“We have therapies for hepatitis C requiring only two or three months of medication, leading to over 95% of patients being cured,” stated Megan Curtis, MD, an assistant professor in the Division of Infectious Diseases in the John T. Milliken Department of Medicine at WashU Medicine, who oversaw both studies. “Yet, we still face challenges in delivering these treatments to the populations most in need. These types of studies assist us in pinpointing where the obstacles lie.”
Unequal access to hepatitis C treatment for children
Curtis has concentrated her research on identifying which patients face hurdles in accessing hepatitis C treatment. Utilizing anonymized data from a nationwide database, she identified 928 pediatric patients who tested positive for hepatitis C from 2000 to 2022.
In the study published in Pediatrics, Curtis observed that only about one in eight of these children received treatment for hepatitis C, and this figure was influenced by various factors. Children born between 2014 and 2018 were more likely to receive treatment compared to those born earlier, likely reflecting changes in Medicaid and insurance coverage during that time, alongside increasing treatment availability for younger patients in subsequent years. Nevertheless, the treatment rate for this group was still considerably lower than that of adult patients with hepatitis C.
The research highlighted ethnic and racial disparities as well. Compared to Black children, Hispanic children had approximately double the likelihood, while White children had about three times the likelihood of receiving care for hepatitis C. Geographic region also influenced disparities, as children with hepatitis C residing in the South were the least likely to receive treatment compared to those in other regions.
While these disparities likely stem from socioeconomic hurdles in accessing health services and regional provider availability, Curtis pointed out that additional factors may contribute to the low overall treatment rates among children.
“Parents may also postpone treatment due to the challenges of administering medication to a young child,” she noted, “and healthcare professionals may delay treatment because some children with hepatitis C will spontaneously clear the virus. However, this isn’t universally applicable.”
Treatment for recently postpartum women falls behind
Hepatitis C infections have been on the rise among individuals with opioid use disorders. Within this group, men have been identified as more likely to receive hepatitis C treatment compared to women. To explore this disparity, Curtis, in partnership with Kevin Xu, MD, an assistant professor of psychiatry and co-senior author of the study in Obstetrics & Gynecology Open, and their team aimed to determine if recent pregnancy was influencing these gender differences.
Since individuals with opioid use disorder are at a heightened risk of contracting hepatitis C, the researchers utilized an administrative claims database and comparable epidemiologic methods as in the pediatric study to examine data on patients receiving treatment for opioid use disorder who also tested positive for hepatitis C. They discovered that recent pregnancy was strongly linked to a lower likelihood of receiving treatment for hepatitis C. Recently postpartum patients with hepatitis C were nearly 30% less likely to receive antiviral treatment than men (31.8% compared to 40.6%, respectively), and about 11% less likely than women who were not recently pregnant (31.8% versus 35.7%).
Caroline Cary, a third-year medical student at WashU Medicine who is the lead author of the study, remarked that the findings indicate a need for additional resources to reach patients who may be overlooked.
“Individuals with hepatitis C often remain asymptomatic for years after exposure, so if you are young, otherwise healthy, and have just had a baby, seeking prompt treatment may not be a priority, especially if it is challenging to obtain,” said Cary. “It’s crucial to enhance access to hepatitis C care for new mothers, considering the long-term effects of the infection.”
For Curtis, this is a significant concern as early and consistent treatment for hepatitis C is highly effective.
“We must develop better strategies for tackling hepatitis C,” she asserted. “We have all the resources necessary to eradicate it. We possess medications that can treat it. We know the populations that require it. We just need to enhance availability and increase awareness. We could eliminate hepatitis C within a generation.”
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. April 18, 2025. DOI: 10.1542/peds.2024-068565
This research was supported by National Institutes of Health grant numbers T32AI052074, T32AI007433, National Institute of Drug Addiction P30DA040500 and 1K01DA052821, the James and Audrey Foster MGH Research Scholar Award, the Charles A. King Trust Postdoctoral Research Fellowship, the Providence and Boston Center for AIDS Research P30AI042853, the Boston University Clinical and Translational Science Institute 1UL1TR001430, and a Boston University Chobanian & Avedisian School of Medicine Department of Medicine Career Investment Award. The content solely reflects the authors’ views and does not necessarily represent the official views of the NIH.
Cary CB, McCrary LM, Marks LR, Kelly JC, Hartz SM, Hayibor L, Grucza RA, Xu KY, Curtis MR. Association between sex and recent pregnancy and hepatitis C virus treatment in people with opioid use disorder. Obstetrics & Gynecology Open. July 10, 2025. DOI: 10.1097/og9.0000000000000096
This work was funded by National Institutes of Health grant numbers K12DA041449, K08DA061258, P50 MH122351, R21 DA057493, R01 HD113199, and R61 DA06232. The content solely reflects the authors’ viewpoints and does not necessarily reflect the official views of the NIH.
About Washington University School of Medicine
WashU Medicine is a prominent institution in academic medicine, encompassing biomedical research, patient care, and educational programs with 2,900 faculty members. Its National Institutes of Health (NIH) research funding portfolio is the second largest among U.S. medical schools and has expanded by 83% since 2016. Alongside institutional investments, WashU Medicine dedicates over $1 billion annually to both fundamental and clinical research innovation and education. Its faculty practice consistently ranks within the top five nationally, with over 1,900 faculty physicians serving at 130 sites. WashU Medicine physicians primarily staff Barnes-Jewish and St. Louis Children’s hospitals — the academic hospitals of BJC HealthCare — and deliver care at community hospitals across the region. WashU Medicine boasts a distinguished history in MD/PhD training, having recently allocated $100 million towards scholarships and curriculum enhancement for its medical students, and offers top-tier training programs across all medical subspecialties, in addition to physical therapy, occupational therapy, and audiology and communication sciences.
Originally published on the WashU Medicine website
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