Challenges and Controversies

There are no large clinical trials of HCV treatment during pregnancy. Small studies evaluating ledipasvir/sofosbuvir treatment during pregnancy have shown excellent efficacy without emergent safety concerns; however, data on the commonly used pan-genotypic drugs, including sofosbuvir/velpatasvir and glecaprevir/pibrentasvir are lacking. Given the risk of mother-to-child (e.g., vertical) transmission of HCV, the AASLD/IDSA HCV guidance recommends treating women of childbearing age before becoming pregnant, if feasible, to minimize the risk of vertical transmission. In this scenario, I would not delay HCV treatment, but I would counsel the patient and her partner that there are limited data on the use of direct acting antivirals in pregnancy, and their safety cannot be assured. Because of this, they may consider using contraception and delaying pregnancy until her HCV treatment is complete.

There are several answers here that I think would be good options. I probably would not want to treat her if she is not on birth control and wanting to get pregnant although there has been some small studies on DAA's and pregnancy. However, I do not believe at what stage in pregnancy DAAs are safe has been determined. On the other side, if we do not treat her before pregnancy there is a small risk of fetal transmission and her viral load is >1 million which is a risk factor.
Using the patient centered care model, I would discuss risks/benefits of treating now and holding off on pregnancy for 5-6 months or treating after pregnancy and breastfeeding as she has mild fibrosis so there is not a rush to treat.