Holistic, collaborative, multidisciplinary, and integrated communication between physicians and women of childbearing age is lacking, according to a study published in 

 Medical treatment and family planning, particularly among women of childbearing age with rheumatoid arthritis (RA) and psoriatic arthritis (PsA), should be considered within this patient population. Patient-centered care including reproductive choices should be integrated as a part of routine clinical practice.

“The proportion of women being treated with biologics is growing,” investigators explained. “However, data on treatment recommendation awareness among treating physicians and women who are considering pregnancy and family planning are limited.”

An English-language, 55-question survey was developed to identify the current practices of physicians regarding the reproductive health needs of women with RA, PsA, and psoriasis in the Czech Republic, Slovakia, and Hungary. The questionnaire was designed to simultaneously elicit spontaneity of physicians while allowing for the processing of responses, mutual comparison, and overall assessment. The survey obtained information from 120 physicians, including 82 rheumatologists and 38 dermatologists.

Female patients of reproductive age (aged 18 to 45 years) with moderate-to-severe disease encompassed 10-30% of all respondents. Roughly two-thirds of physicians discussed family planning with their patients when making the diagnosis. Rheumatologists collaborated with other specialists more frequently when compared with dermatologists and gynecologist/obstetricians. Pregnancy effects were the top concern for female patients.

Approximately half of the rheumatologists revised treatment 6 months prior to when the patient planned on becoming pregnant (44% [n = 36/81]). However, dermatologists acted much sooner (26% [n = 10/38]), acting 2 to 3 years prior planned parenthood. While rheumatologists selected systemic glucocorticoids as firs-line treatment to counteract pregnancy flares, dermatologists preferred topical corticosteroids.

Although gender alone did not influence treatment choice in 11% of dermatologists and 39% of rheumatologists, all dermatologists and 96% of rheumatologists were influenced by the patient’s fertility and pregnancy. Disease severity and uncontrolled disease were the main risk factors linked to conception in this patient population. In fact, 53% of dermatologists and 79% of rheumatologists believed that poor disease control was associated with poor pregnancy outcomes. Of the most valuable sources of information as determined by physicians, congresses and interdisciplinary forums were the most highly rated. Patient education and collaboration were noted as key factors in reducing unplanned pregnancies.

A cross-border investigation, from the perspective of both rheumatologist and dermatologist, strengthened the study. However, investigators did not evaluate or categorize the individual physicians’ level of experience with biologics or reproductive health and instead based data on actual clinic experience. Investigators theorize that those who have had more exposure to this approach would be more willing to utilize it. The lack of formal survey validation, and the fact that the survey was provided in English, further limits the study.

“To improve the reproductive health of sexually active women of childbearing age in Central Europe who have chronic inflammatory diseases (CID), rheumatologists and dermatologists must improve their education and work with other specialists,” investigators concluded. “More timely discussions with women of reproductive age and family planning are needed to educate them about the disease's effects on their childbearing potential and the selection of treatment options based on their reproductive goals. Best practices in patient-centered care must consider each patient's reproductive decisions in their treatment planning to give the best patient-centered care.”

This article originally appeared on Rheumatology Network®. 

Olejárová M, Macejová Ž, Gkalpakiotis S, Procházková L, Tóth Z, Prágr P. Reproductive Healthcare in Women with Rheumatoid Arthritis and Psoriatic Diseases in Routine Clinical Practice: Survey Results of Rheumatologists and Dermatologists [published online ahead of print, 2022 Sep 24]. Rheumatol Ther. 2022;10.1007/s40744-022-00488-z. doi:10.1007/s40744-022-00488-z

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Although the proportion of women treated with biologics continues to grow, data on treatment recommendations among both physicians and female patients of childbearing age remain limited.

Survey addresses concerns regarding reproductive health care communication in women with RA, PsA

“The COVID-19 pandemic in spring 2020 precluded most in-person education, with new constraints on in-person teaching,” said the study’s co-author Suzan Goodman, MD, MPH, national training director for the Bixby Beyond the Pill Program at the University of California, San Francisco (UCSF), and clinical professor of family and community medicine at UCSF. “There was also patient demand for more streamlined service-delivery models to facilitate contraceptive care, especially in rural and geographically dispersed areas.”

The relative dearth of literature on virtual IUD training models also inspired the authors to initiate the study and meet the growing needs of the field.

The University of New Mexico Long-Acting Reversible Contraceptives Mentoring Program in Albuquerque, New Mexico—and UCSF—collaborated to develop the innovative, virtual hands-on IUD training model.

Prior to the virtual training, attendees watched a pre-training didactic video on patient eligibility and counseling and received in the mail a pelvic model, IUD demonstration kit, instruments, and a phone-camera tripod to support visualization of a model cervix and uterus.

A total of 34 New Mexico clinicians were trained, comprising a virtual session lasting 1.5 hours, from January to June 2021.1 the virtual session was conducted via 1-on-1 Zoom video or small group conferencing, during which time trainees practiced loading, placing, and removing all Food and Drug Administration (FDA)-approved IUDs, and reviewed challenging cases. The pelvic model and instruments were mailed back after training.

Surveys given to trainees before and immediately after training assessed clinician satisfaction and evaluated pre-to-post training changes in self-rated comfort level with IUD procedures.

Of the 32 trainees who responded to pre/post surveys, 48% were nurse practitioners and midwives, 28% physician assistants, 17% physicians and 7% clinicians-in-training. Overall, 37% of respondents had previous experience placing IUDs.

All elements of training delivery were highly rated by clinicians, with all trainees successfully using the virtual platform. Also, 50% indicated that in the future they would potentially choose virtual training over in-person.

After the training, clinicians reported significantly increased comfort with all aspects of IUD placement and removal (

In addition, all respondents said they would recommend the training to a colleague.

“While virtual trainings were highly rated and increased clinician comfort with IUD placement and removal, I was surprised that half said that they would choose a virtual training over an in-person option in the future,” Goodman told 

. “This is a much higher rate than I would have anticipated.”

She also found unexpected that none of the clinicians reported difficulty using the virtual platform and that findings were consistent, regardless of provider IUD experience.

“In the face of increasing legal constraints on reproductive care, it is ever more important that all providers serving patients with pregnancy potential offer the full range of contraceptive services, rather than having to further fragment patient care,” said Goodman. “However, it may be challenging for one trainer to work with more than three simultaneous virtual learners to effectively guide participants through hands-on procedures over Zoom.”

The virtual practicum has utility during phases of the on-going COVID-19 public health emergency, plus in geographically large and rural settings, according to Goodman. “Virtual IUD training is also helpful where there are high demands on clinician time to simplify logistics, such as easier scheduling and no travel time, and in settings facing reproductive health bans or patient surges,” she said.

Sebastian RA, Robinson J, Rayburn E, et al. Virtual intrauterine device placement training improves clinician comfort. 

Practicing clinicians were highly impressed with an interactive, virtual intrauterine device (IUD) training model that increased their comfort with IUD placement and removal, according to a study published in the journal Family Medicine.

Virtual IUD placement training improves clinician confidence

 of published literature also indicates that using more data collection methods, analyses and definitions for these unmet needs would enable a clearer understanding of health inequality.

Five databases were searched for studies published between 2010 and 2021 that described quantitative measurement of unmet need within sexual and/or reproductive health: PubMed, Web of Science, Scopus, the Cumulative Index to Nursing and Allied Health Literature and Health Management and Policy Database.

The review consisted of 216 studies, of which 190 were analyses of unmet need in reproductive health. Of those 190 studies, 179 collected information via questionnaires.

Among the 190 studies in reproductive health, 137 analyzed trends in populations living in low or lower-middle income countries, compared to only 51 studies that comprised populations from upper-middle and high-income countries. The 2 remaining studies were global comparisons.

Half of the reproductive health studies extrapolated at the national or multinational level, while the other half focused on the regional level.

Six of these 190 studies considered the contraceptive needs of men. The other 184 studies were limited to unmet need in women, of which 89 analyzed women of reproductive age only. A significant majority of studies also restricted analysis to married women or who were in a union similar to marriage.

Overall, 165 of the 216 studies used the Demographic and Health Surveys definition of unmet need. “According to this definition, women are considered to have unmet need if they report being fecund and sexually active, would like to stop or postpone childbearing, and are not currently using a modern contraceptive method,” wrote the authors.

The authors noted that “unmet need for family planning” is a key indicator of the United Nations, without much discourse of unmet need in other areas of sexual and reproductive health. It is also easier to define and measure unmet need for contraception than for sexual health because of the defined endpoint for contraception: unplanned pregnancy.

By contrast, measuring unmet need in sexual health is much more difficult, due to the lack of data from people not receiving care.

Because there remains a large and under-treated global burden of morbidity in sexual health, the conceptualization and measurement of unmet need in sexual health should be a research priority, according to the authors.

There is also a need for data collection using a range of methods that reflect regional patterns, sub-group trends and can begin to determine the causes of unmet need.

“If these gaps are not addressed, we run the risk of repeatedly measuring unmet need within sexual and reproductive health but not collecting the data that will allow us to make significant and sustainable change,” wrote the authors.

Solomon D, Cabecinha M, Gibbs J, et al. How do we measure unmet need within sexual and reproductive health? A systematic review. 

. Published online September 20, 2022. doi:10.1177/17579139221118778

A systematic review on measuring unmet need in sexual and reproductive health has concluded that the emphasis is on contraception for women in low-income countries, while unmet need for sexual health in general, especially among men, and unmet reproductive health need in high-income settings lack much evidence. 

Measuring the unmet need of sexual and reproductive health

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Tune into this valuable discussion with host Scott Kober and experts Rachel Pope, MD, MPH, and Sheryl Kingsberg, PhD, as they highlight the overall impact of vaginismus and discuss strategies to combat its effects on women who are diagnosed the condition.

Vaginismus: Managing a Misunderstood and Underdiagnosed Condition

COVID-19 vaccination has been associated with an increase in menstrual cycle length of less than 1 day, based on a large international study.

The study, which was funded by the National Institutes of Health and published in the 

, gathered data from almost 20,000 people across the world who had received any of the 9 different COVID-19 vaccinations. In most participants, menstrual cycle length saw an increase after the vaccine was administered.

“These findings provide additional information for counseling women on what to expect after vaccination,” said Diana Bianchi, MD, director of National Institute of Child Health and Human Development. “Changes following vaccination appear to be small, within the normal range of variation, and temporary.”

This change in cycle is under 8 days, making it fit within the normal range of variation. While not concerning from a professional standpoint, the study authors noted that even minor changes in bodily function surrounding fertility may cause concern and increase vaccine hesitancy.

Data was gathered from a fertility tracking app called Natural Cycles, where women voluntarily provided information on menstrual cycles and body temperature. Over 19,000 individuals participated, with almost 15,000 being vaccinated against COVID-19 while over 4500 were not.

Over 30% of participants were from the United Kingdom, while about 30% were from the United States and Canada, and almost 35% from Europe. Participants were included if they had received any of the following vaccinations: Pfizer-BioNTech, Moderna, AstraZeneca, Covishield, Janssen/Johnson & Johnson, Sputnik, Covaxin, Sinopharm, and Sinovac.

The study period lasted at least 4 consecutive cycles, with at least 3 before vaccination and at least 1 after vaccination being studied. In the cycle after vaccination, vaccinated individuals experienced an average increase of less than 1 day, increasing by about 70% of a day after the first dose and about 55% after the second dose.

Over 1300 participants experienced an increase in cycle length greater than 8 days, making up 6.2% of those vaccinated and 5% of those unvaccinated. This increase was mostly likely in younger woman who had experienced longer circle length prior to vaccination.

The authors recommended further studies to observe other potential physical changes, along with the reasons these changes occur.

Study confirms link between COVID-19 vaccination and temporary increase in menstrual cycle length. National Institutes of Health. September 27, 2022. Accessed September 27, 2022. 

https://www.nih.gov/news-events/news-releases/study-confirms-link-between-covid-19-vaccination-temporary-increase-menstrual-cycle-length

In a recent study, participants who had received a COVID-19 vaccine saw an average increase in menstrual cycle length of less than 1 day.

COVID-19 vaccine associated with increased menstrual cycle length

You can reach her a lcarr@mjhlifesciences.com.

Self-reported screening forms may be the key to improving average diagnostic time of endometriosis—10 years—according to a recent poster presentation at the ­NPWH's 25th Annual Premier Women's Healthcare Conference held in Houston, Texas, from September 29 to October 2, 2022.

The poster outlined results from the researchers’ quality improvement project. The purpose of the project was to create and execute an evidence-based screening protocol for endometriosis in a gynecological setting, which had 2 primary goals: increase endometriosis diagnosis via laparoscopy by 20% and identify symptoms prior to 10 years of onset.

Modeled after National Institute for Health and Care guidelines, the research team developed a self-reported screening questionnaire, which was ultimately given to 911 women. It was distributed to women ages 18 to 49 at their annual exams or during visits with symptoms of dysmenorrhea, dyspareunia, abdominal and/or pelvic pain.

The completed questionnaires were then organized by negative, suspicious, or positive, with the use of a screening scale and/or at the discretion of the medical provider.

More than 140 women were suspicious of endometriosis and 65 were confirmed with surgical laparoscopy. Researchers also used the paired t-test to compare pre- and post-project lasers, which showed a significant increase (P=0.42). The number of lasers performed had increased by 25% from 2020 and 2021. The screening questionnaire also resulted in diagnoses before the average 10 years for 76.6% of patients.

This method of screening, they said, allowed for patient verbalization that revealed previous dismissal of symptoms, and signify a need for standardized screening protocol. The self-reported screening method was ultimately successful in increasing timely identification of endometriosis, but the authors suggest its use should be trialed in other gynecological offices. These results, they concluded, may lead to an acceleration of endometriosis diagnoses, and improve medical management going forward.

King S, Peterson C, Adams K. Reliable Evidence-Based Protocol for Endometriosis. Poster presented at: 25th Annual Premier Women's Healthcare Conference. Houston, Texas. September 29 to October 2, 2022.

Women in the United States go undiagnosed with endometriosis for an average of 10 years before receiving a proper diagnosis. Self-reported screening may be the answer, according to a poster presentation at the Nurse Practitioners in Women’s Health (NPWH) 25th Annual Conference in Houston, Texas from September 28 to October 2022.

Self-reporting could improve endometriosis diagnoses and symptom management 

 and joined the MJH Life Sciences team in December 2019. She graduated from Youngstown State University in 2019 with a bachelor's degree in journalism and a minor in political science. Prior to graduating, Morgan worked as the editor-in-chief of her college newspaper. She went on to work as an assignment editor at a broadcast news station in Youngstown, Ohio before joining 

It is important to know what is normal and what is abnormal when it comes to the vulva, especially when diagnosing and treating vulvar-afflicted diseases, according to a recent presentation.

This presentation focused on vulvar dermatology and was given by Jean Marino, APRN-CNP, NCMP, IF, at the ­25th Annual Premier Women's Healthcare Conference held in Houston, Texas, from September 29 to October 2, 2022.

Marino began her presentation by stating that the default is for the genitals to develop into females, but the introduction of androgens is how it differentiates. When it comes to females, the vulvovaginal area is made up of 3 embryological layers, including: the vulva (ectoderm), vestibule (endoderm), and vagina (mesoderm).

Both estrogen and androgen play a role in the vulvovaginal area by maintaining blood flow, protecting against harmful pathogens, and supporting the tissue and microbiome. Additionally, Marino said both androgens and estrogen are integral for vascular health and signaling sexual responses. Different embryological layers responding to different hormone groups. For example, the vulva and vestibule respond to androgen, while the vagina responds to estrogen.

Marino then presented a few cases that demonstrated normal vulvovaginal areas vs scenarios that required further exploration. One such case demonstrated prolonged pruritus, multiple doses of fluconazole, and burning pain after intercourse.

Marino stated that some common reasons for vulvovaginal pruritus include contact dermatitis, trichomonas, vulvovaginal candidiasis, lichen sclerosus, lichen simplex chronicus, and genitourinary syndrome of menopause. She added that when diagnosing your patients with complaints of vulvovaginal pruritus, to ask if they have any concern for STI exposure, if they have self-treated, and what their vulvar and vaginal hygiene is like.

If you suspect vulvovaginal candidiasis, Marino said to watch out for fissures, erythema and edema, no change in pH levels, vaginal discharge or lack thereof, as well as itching, irritation. Pain. Itching, and dysuria.

When it comes to treatment, Marino suggested either azoles (fluconzazole and terconazole), which inhibit fungal growth, or ibrexafungerp, which kills candida species.

Other cases were presented that covered a wide variety of symptoms including diseases associated with pruritus such as genitourinary syndrome of menopause, contact dermatitis, lichen sclerosus, lichen simplex chronicus. Cases on pain-related diseases such as vulvodynia and vestibulodynia, and erythema-related disease like genital psoriasis and vulvar lichen planus were also presented.

Marino concluded her presentation with some valuable key takeaways for the audience:

The disease is not ruled out if the biopsy does not confirm what you expect.

A thorough history and physical exam that includes hygiene and treatment is crucial.

A little clobetasol goes a long way and consider the likelihood of yeast

Before you refer to pelvis floor physical therapy or dilator use, ensure the tissue is healthy.

Potential negative body image and the patient’s sexual health is important to keep in mind.

Vaginal estrogen is great, especially in menopause.

Disclosures: Jean Marino, APRN-CNP, NCMP, IF, is on the advisory board for Scynexis and is a partial owner of The Menopause Retreat.

Marino J. Vulvar Dermatology. Presented at: 25th Annual Premier Women's Healthcare Conference. Houston, Texas. September 29 to October 2, 2022.

Knowing what is normal and abnormal with the vulvovaginal area is crucial for accurate diagnosis, according to a presentation at the 25th Annual Premier Women's Healthcare Conference held in Houston, Texas.

How to navigate vulvar dermatology

Almost half of all cervical cancer diagnoses are the result of a lack of follow-up after abnormal Pap results, and while the American Society for Colposcopy and Cervical Pathology (ASCCP) routinely develops risk-based algorithms for abnormal Pap result management and treatment, many practices are not in compliance because of the algorithms’ increasing levels of complexity.

To reduce practice- and provider-related barriers to abnormal Pap follow-up, and to increase compliance with ASCCP guidelines, researchers developed a quality improvement plan.

The plan included an improved electronic health record (EHR) tracking and reminder system, which was developed and implemented at a large midwifery and women’s health practice in Utah. They issued post-intervention surveys to practitioners to measure acceptability and appropriateness, and to gauge how feasible it would be to implement the tracking and reminder system in other practices. To evaluate provider experience and satisfaction with the tracking system and gauge its success in reducing barriers to follow-up, researchers conducted post-intervention interviews.

Ultimately, they found that all surveyed providers (n=18) reported that the improved Pap tracking system reduced difficulty in managing abnormal Pap follow-up and helped to ensure that patients received appropriate follow-up care. Almost all providers (n=17) said the system helped reduce errors and cut down on time spent managing abnormal results. All providers (n=18) approved of the tracking system and saw it fit for improving ASCCP guideline compliance. Results also indicated a unanimous approval for implementing the system at other practices.

Although the research period has concluded, these providers continue to use the improved EHR tracking and reminder system because of the positive results it provided. Next steps, the authors wrote, include initiating EHR tracking functionalities within other practices that offer cervical cancer screenings.

Fuqua D, Taylor-Swanson L, Cole E. Cervical Cancer Prevention: Improving Abnormal Pap Follow-Up. Poster presentation at the 2022 Nurse Practitioners in Women’s Health 25th Annual Conference. September 28-October 2, 2022. Houston, Texas.

An improved electronic health record tracking and reminder system improves patient follow-up after abnormal Pap results and increases compliance with ASCCP guidelines, according to a poster presentation at the Nurse Practitioners in Women’s Health (NPWH) 25th Annual Conference in Houston, Texas from September 28 to October 2022.

Electronic health record tracking system may improve follow-ups after abnormal Pap results

The NPWH is a national professional organization focused on women’s health, whose members include women’s health nurse practitioners, nurse-midwives, and other advanced practice registered nurses within the women’s health care space.

The conference represents not only the 25th anniversary event, but also the first time the organization has gathered its members in 3 years. The theme this year—Reunite, Persevere, Renew—recognizes the contributions made by women’s health practitioners and their dedication to the field during the ongoing COVID-19 pandemic.

The agenda is full of informative and engaging sessions, hands-on learning opportunities, and networking events. The 

 team is live on-site, so stay tuned for coverage on a plethora of topics, including, but not limited to:

Environmental exposures and their impact on women’s health

Administering mifepristone and misoprostol for early pregnancy loss management

What’s new in obesity management medications

The organization addressed its decision to keep the conference in Houston via a statement after several members raised concerns, primarily due to the original abortion ban known as Texas State Senate Bill 8. They noted the decision-making processes and lead time that were necessary for selecting a conference location. The NPWH began the process approximately 3 to 4 years ago, when they began surveying conference attendees and members for location feedback. Hotel space, lodging options and fair prices were all taken into consideration.

Shortly after they signed the Houston contract in 2019, they were faced with COVID-19 restrictions that ultimately prohibited in-person conferences in 2020 and 2021. To minimize financial loss and refrain from breaking the contract, the organization chose to renegotiate for an in-person conference.

The NPWH emphasized its commitment to providers, citing that the state of Texas has thehighest number of WHNP-BCs in the country. “Texas also has the 8th highest mortality rate in the United States. The high-quality, clinical, and evidenced based continuing education NPWH provides at our annual women’s healthcare conference is vitally important to the health and safety of Texas women, pregnant people, and children. It is imperative that we support our women’s and gender-related healthcare colleagues across the country equitably, regardless of the state in which they live.”

 to get live updates and daily recaps delivered right to your inbox.

The National Association of Nurse Practitioners in Women’s Health (NPWH) begins their 25th Annual Premier Women’s Healthcare Conference today in Houston, Texas, which will continue until Sunday, October 2, 2022. Follow along for coverage. 

NPWH 2022 has officially begun: What to expect from the 25th Annual NPWH Premier Women’s Healthcare Conference

Pregnant women with higher viral loads of 

 (HCV) are at an increased risk of transmitting the virus to their offspring.

A team, led by Songqing Deng, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, assessed the link between maternal HCV viral load and HIV coinfection and the risk for mother-to-child transmission among pregnant women infected with HCV.

In the study, the investigators explored various databases from inception to June 21, 2022 that reported the incidence of HCV mother-to-child transmission.

They calculated pooled effect estimates using the random-effects model and Holm-Bonferroni correction for multiple pooled associations.

The final analysis included 26 studies involving 4934 newborns with maternal HCV infections. The investigators found pregnant women with HCV viremia showed an increased risk of mother-to-child transmission (OR, 8.25; 95% CI, 4.65-14.63) compared to those with negative for HCV-RNA.

After conducting multiple subgroup analysis, the investigators found that the HCV viremia/HIV-positive group had a higher risk of HCV mother-to-child transmission, followed by the HCV viremia mono-infected group.

On the other hand, HCV-RNA-negative women showed the lowest risk for HCV mother-to-child transmission.

For female patients with HCV viremia, the elevated risk of mother-to-child transmission was found among subjects with a viral load ≥6 log10 copies/ml compared to those with viral load < 6 log10 copies/ml (OR, 4.58; 95% CI, 2.52–8.34).

“The incidence of HCV MTCT was increased among pregnant women with detectable HCV viremia, and was even higher in those with a viral load ≥6 log10 copies/ml,” the authors wrote. “HIV coinfection further increased the risk for HCV MTCT.”

Recently, a new analysis of pregnant women in India shows mostly vertical transmission of 

A team, led by Suprabhat Giri, Department of Gastroenterology, Nizam's Institute of Medical Sciences, determined the pooled seroprevalence of HBV and its associated demographic factors.

HBV infections during pregnancy can often lead to perinatal transmission of the virus, contributing to the pool of HBV infections within the population. However, there is a wide variation in the data reported on the seroprevalence of HBV in pregnancy patients from various regions in India.

The pooled prevalence of hepatitis B e antigen was 26.0% (95% CI, 17.4-34.7) among patients with HBsAg positivity.

However, the investigators did not find significant differences in the odds of HBV seroprevalence based on the age (<25 years vs. > 25 years) (OR, 1.07; 95% CI, 0.74–1.55), parity (primipara vs. multipara) (OR, 1.09; 95% CI, 0.70–1.70), or area of residence (urban vs. rural) (OR, 0.88; 95% CI, 0.56–1.39).

On the other hand, the odds of HBV seroprevalence in participants with no or primary education was higher than individuals with secondary level education or higher (OR, 2.29; 95% CI, 1.24–4.23).

The investigators also found a prior history of risk factor was identified in 13.5-22.7% of patients, which indicates a vertical mode of acquisition.

Hepatitis C viral load and mother-to-child transmission: a systematic review and meta-analysis

Journal of Gastroenterology and Hepatology

This article originally appeared on HCPLive®.

Among pregnant women coinfected with HIV, a higher hepatitis C viral load increased the likelihood of transmitting HCV to children.