Benefits and Risks of Antiviral Treatment during Pregnancy in Patients with Chronic Hepatitis B

Lee, Yoon Seok; Bang, Soo Min; Lee, Young‐Sun

doi:10.3390/jcm10112320

Cited by 12 publications

(6 citation statements)

References 84 publications

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“…The risk of intrauterine infections can be reduced if the mother receives antiviral therapy during pregnancy [ 24 , 34 ], prompting the WHO to recommend the administration of tenofovir in the third trimester of pregnancy until at least birth in pregnant women with high viral load, i.e.load 200,000 IU/mL (equivalent to 10 6 copies/mL) [ 35 ]. In resource-limited countries, WHO recommends using HBeAg as an alternative to viral quantification.…”

Section: Discussionmentioning

confidence: 99%

Residual risk of mother-to-child transmission of HBV despite timely Hepatitis B vaccination: a major challenge to eliminate hepatitis B infection in Cambodia

Bunthen

Kim

et al. 2023

BMC Infect Dis

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Background In countries with intermediate or high hepatitis B virus (HBV) endemicity, mother-to-child transmission (MTCT) represents the main route of chronic HBV infection. There is a paucity of information on HBV MTCT in Cambodia. This study aimed to investigate the prevalence of HBV infection among pregnant women and its MTCT rate in Siem Reap, Cambodia. Methods This longitudinal study included two parts, study-1 to screen HBsAg among pregnant women and study-2 to follow up babies of all HBsAg-positive and one-fourth of HBsAg-negative mothers at their delivery and six-month post-partum. Serum or dried blood spot (DBS) samples were collected to examine HBV sero-markers by chemiluminescent enzyme immunoassay (CLEIA), and molecular analyses were performed on HBsAg-positive samples. Structured questionnaires and medical records were used to examine the risk factors for HBV infection. MTCT rate was calculated by HBsAg positivity of 6-month-old babies born to HBsAg-positive mothers and ascertained by the homology of HBV genomes in mother–child pair at 6-month-old. Results A total of 1,565 pregnant women were screened, and HBsAg prevalence was 4.28% (67/1565). HBeAg positivity was 41.8% and was significantly associated with high viral load (p < 0.0001). Excluding subjects who dropped out due to restrictions during COVID-19, one out of 35 babies born to HBsAg-positive mothers tested positive for HBsAg at 6 months of age, despite receiving timely HepB birth dose and HBIG, followed by 3 doses of HepB vaccine. Hence the MTCT rate was 2.86%. The mother of the infected baby was positive for HBeAg and had a high HBV viral load (1.2 × 109 copies/mL). HBV genome analysis showed 100% homology between the mother and the child. Conclusions Our findings illustrate the intermediate endemicity of HBV infection among pregnant women in Siem Reap, Cambodia. Despite full HepB vaccination, a residual risk of HBV MTCT was observed. This finding supports the recently updated guidelines for the prevention of HBV MTCT in 2021, which integrated screening and antiviral prophylaxis for pregnant women at risk of HBV MTCT. Furthermore, we strongly recommend the urgent implementation of these guidelines nationwide to effectively combat HBV in Cambodia.

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Section: Discussionmentioning

confidence: 99%

Residual risk of mother-to-child transmission of HBV despite timely Hepatitis B vaccination: a major challenge to eliminate hepatitis B infection in Cambodia

Bunthen

Kim

et al. 2023

BMC Infect Dis

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“…The increasing number of mothers were receiving early medical treatment and regular prenatal examinations. Therefore, the risk of liver failure or MTCT (mother-to-child transmission) is signi cantly reduced 9,37 .…”

Section: Discussionmentioning

confidence: 99%

Analysis of prognostic factors and construction of prediction model for pregnancies with liver failure

Lin,

Luo,

Chen

et al. 2023

Preprint

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Background and objectives: Liver failure during pregnancy adversely affectsmothers. However, it is not thoroughly found which its prognostic factors are. In the present study, we explored some factors which could affect the short-term prognosis. Furthermore, a logistic regression model (LRM)was constructed to predict the outcomes of mothers. Method: One hundred and twenty-nine pregnant women with liver failure were enrolled in this study. The mothers were treated at several hospitals in Guangzhou from January 2008 to September 2022. Ninety-six patients were divided into an effectual group (n=76) and an ineffectual group (n=20). Retrospective and logistic regression analyses were performed to screen for possible prognostic factors and to construct LRM. The remaining 33 cases, combined with the original 96 cases, were used to validate the model. Results: Age, |Na-135|, and INR are independent risk factors for liver failure. The area under the curve (AUC) for LRM and MELD are 0.896 and 0.780, respectively. Thesensitivity of the two models was 95.83% and 70.83%, respectively. The specificity was 71.43% and 75.24%, respectively. The total prediction accuracy rate was 75.97% and 74.42%, respectively. Conclusion: Age, |Na-135|, and INR were independent risk factors for pregnant women with liver failure with poor prognosis, both the LRM and the MELD could predict the prognosis, however, the LRM was superior to the MELD in terms of sensitivity.

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“…Most studies found that nucleoside analog therapy in late pregnancy, followed by treatment withdrawal early postpartum, was associated with ALT flare; however, they reported variable changes in HBV DNA levels or rates of HBeAg seroconversion during immediate postpartum up to 1 year of follow-up [ 8 , 11 , 14 – 16 ]. The definition of a hepatitis flare varies according to the literature [ 7 , 17 , 18 ], but a significant increase in serum ALT levels from the baseline level or higher than ULN is generally defined as ALT flare [ 10 ]. In this observational study, the rate of postpartum ALT flare was 69%.…”

Section: Discussionmentioning

confidence: 99%

Antiviral Therapy for a Postpartum Flare in Women with Chronic HBV Infection Shortens the ALT Recovery Time and Reduces Hepatitis Re-Flare Rates within 4 years

Quan

Liu

et al. 2022

Canadian Journal of Gastroenterology and Hepatology

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Background. Few studies explored whether anti-hepatitis B virus (HBV) therapy should be initiated during postpartum hepatitis flare. Aim. This study aimed to analyze the effect of anti-HBV therapy on postpartum hepatitis flare and evaluate the prognosis within 4 years postpartum. Methods. This retrospective study enrolled hepatitis B surface antigen (HBsAg)-positive and hepatitis B e antigen (HBeAg)-positive pregnant women with HBV DNA ≥ 106 IU/mL. A total of 152 pregnant women were included: 103 in the prophylactic anti-HBV therapy group (PT-G) and 49 in the non-prophylactic anti-HBV therapy group (NPT-G). The women with a postpartum flare were assigned to the anti-HBV therapy group (AT-G) and non-anti-HBV therapy group (NAT-G) to analyze the effect of postpartum anti-HBV therapy on hepatitis flare. Virological and biochemical parameters were assessed. Results. Taking postpartum 12 weeks as the cutoff point, the ALT recovered time for postpartum flare women is shorter in AT-G (n = 16, 42.1%) or PT-G (n = 23, 34.8%) than in NAT-G (n = 14, 23.0%; x2 = 4.067, P = 0.044 ) or NPT-G (n = 4, 11.1%; x2 = 5.579, P = 0.018 ). Taking postpartum 26 weeks as the cutoff point, the ALT recovered time is shorter in AT-G (n = 35, 57.3%) or PT-G (n = 44, 66.7%) than in NAT-G (n = 32, 84.2%; x2 = 7.707, P = 0.006 ) or NPT-G (n = 16, 44.4%; x2 = 4.749, P = 0.029 ). Postpartum flare recovery time was positively correlated with HBV DNA level at delivery [r = 0.223, P = 0.025 , 95%CI (0.022～0.41)]. The hepatitis re-flare rates within postpartum 4 years in AT-G (n = 3, 9.68%) is lower than that in NAT-G (n = 24, 45.4%; x2 = 14.003, P ≤ 0.001 ). The HBeAg, HBsAg, HBV DNA, and ALT level at postpartum 4 years in AT-G were lower than that in NAT-G ( P < 0.001 ). Conclusion. Anti-HBV therapy for postpartum hepatitis flare of women with chronic HBV could shorten the ALT recovery time and reduce hepatitis re-flare rates within 4 years of postpartum.

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Benefits and Risks of Antiviral Treatment during Pregnancy in Patients with Chronic Hepatitis B

Cited by 12 publications

References 84 publications

Residual risk of mother-to-child transmission of HBV despite timely Hepatitis B vaccination: a major challenge to eliminate hepatitis B infection in Cambodia

Residual risk of mother-to-child transmission of HBV despite timely Hepatitis B vaccination: a major challenge to eliminate hepatitis B infection in Cambodia

Analysis of prognostic factors and construction of prediction model for pregnancies with liver failure

Antiviral Therapy for a Postpartum Flare in Women with Chronic HBV Infection Shortens the ALT Recovery Time and Reduces Hepatitis Re-Flare Rates within 4 years

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