No abstract

one stopped 6 days before birth. 1 mother continued after delivery due to increased ALT during treatment with ultrasound evidence of liver disease. There were no reported adverse effects. During or at the end of treatment four patients had rises in ALT (>1e2ULN) but no jaundice or hepatic decompensation. All the babies were born healthy and received immunoglobulin and vaccination. Conclusion This small series demonstrates the safety of tenofovir in the last trimester of pregnancy. Small increases in ALT were seen which could be due to pregnancy, the initiation or discontinuation of tenofovir. It is necessary to assess the stage of liver disease to guide the treatment strategy after birth, although this is not always feasible in pregnancy. The timing of tenofovir discontinuation is determined by breastfeeding. We recommended that breastfeeding should start 24 h after treatment cessation, although there is not an evidence base to support this. Long-term prospective studies are indicated to confirm efficacy, safety and to determine optimal discontinuation strategies in relation to breastfeeding. Competing interests None declared.