Chronic HBV with pregnancy: Reactivation flare causing fulminant hepatic failure

Singhal, Ashish; Kanagala, Rajesh; Jalil, Sajid; Wright, Harlan I.; Kohli, Vivek

doi:10.1016/s1665-2681(19)31575-3

Cited by 25 publications

(24 citation statements)

References 19 publications

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“…Both endogenous production and exogenous administration of corticosteroids should be controlled in HBV carriers. Spontaneous reactivation of HBV can occur in inactive HBV carriers even without steroid administration [19], and the risk factors reported were aging [19], diabetes mellitus [20], pregnancy [21], and emotional [22] or physical stress including surgeries [19]. Even the patient with steroid-producing tumors can cause HBV reactivation.…”

Section: Discussionmentioning

confidence: 99%

Case reports of latent HBV hepatitis in patients after neurosurgical treatment for hypothalamic and pituitary tumors

et al. 2020

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Background: Hepatitis B virus (HBV) infection is a major public health problem worldwide. More than 2 billion people have been exposed to HBV, and about 257 million individuals are chronic carriers of HBV. HBV reactivation has been increasingly reported in HBV carriers who have undergone immunosuppression or chemotherapy, resulting in mortality. Treatment of hypothalamic/pituitary tumors in HBV carriers requires extensive care to avoid HBV reactivation as steroid therapy is required after surgery for hypothalamic/pituitary tumors. Case presentation: This retrospective review identified 5 patients, who were HBV carriers positive for hepatitis B surface antigen among 1352 patients with surgically treated hypothalamic/pituitary tumor in Kohnan Hospital between February 2007 and April 2017. Transsphenoidal surgery was performed with particular attention to prevent damage to the pituitary gland, with delicate manipulation to minimize postoperative steroid coverage. All patients received nucleot(s)ide analogue to control HBV-DNA levels before the surgery. As a result, all patients had a good clinical course. Blood examinations found a transient increase of liver enzymes and HBV-DNA levels in all patients, which started to decrease within 2 weeks after surgery. No specific treatment other than nucleot(s)ide analogues was needed to maintain liver function, and all patients returned to their previous activities including reinstatement. Conclusion: Initiation of nucleot(s)ide analogues administration prior to the surgery for hypothalamic/pituitary tumors can be an effective strategy for preventing reactivation in HBV carriers. Appropriate screening of the patient's HBV phase, optimal timing of nucleot(s)ide analogues-administration, and administration period of nucleot(s)ide analogues need to be established.

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Section: Discussionmentioning

confidence: 99%

Case reports of latent HBV hepatitis in patients after neurosurgical treatment for hypothalamic and pituitary tumors

et al. 2020

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“…According to Li et al ., fulminant hepatitis in pregnancy occurs most frequently during late pregnancy and tends to have more severe complications than fulminant hepatitis not developing in pregnancy. Considering prior case reports of hepatic failure in pregnancy, careful monitoring for viral replication in pregnant HBV carriers is important for the prevention of hepatitis exacerbation and for improving perinatal outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…ALTHOUGH POST‐PARTUM EXACERBATION of hepatitis B in hepatitis B e‐antigen (HBeAg) positive carrier mothers has been recognized, there are few reports documenting hepatic failures triggered by acute exacerbation of hepatitis B virus (HBV) infection in pregnancy, and none of the reports present the genome sequence of HBV in these cases. Herein, we report the clinical efficacy of artificial liver support (ALS) in a case with progression of chronic HBV infection to hepatic failure in late pregnancy.…”

Section: Introductionmentioning

confidence: 99%

Hepatic failure in pregnancy successfully treated by online hemodiafiltration: Chronic hepatitis B virus infection without viral genome mutation

Arata

Nozaki

Takizawa

et al. 2013

Hepatology Research

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A 23-year-old nulliparous woman, a hepatitis B virus (HBV) carrier with stable liver functions, presented with exacerbation of viral replication (HBV DNA level >9.0 log copies/mL) in gestational week 26. During the subsequent follow up without antiviral therapy, she was hospitalized with progression to hepatic failure in gestational week 35. Following initiation of antiviral therapy with lamivudine, emergent cesarean delivery was conducted for fetal safety. Liver atrophy and persistent hepatic encephalopathy (stage 2) necessitated artificial liver support (ALS) involving online hemodiafiltration (HDF) and plasma exchange. She regained full consciousness after the sixth online HDF session. ALS was terminated after the seventh online HDF session. On day 33 of hospitalization, she was discharged home without sequelae. Genetic analysis of the HBV strain isolated from her serum showed that this strain had genotype C. Direct full-length sequencing identified no known mutations associated with fulminant hepatitis B. HBV-related hepatic failure observed in the present case might have been related to perinatal changes in the host immune response.

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“…Acute liver failure has been reported during pregnancy in CHB . It is known that cortisol levels peak at term and delivery.…”

Section: Epidemiology Of Hbv and Mtctmentioning

confidence: 99%

Hepatitis B and Pregnancy: Virologic and Immunologic Characteristics

Joshi

Coffin

2020

Hepatol Commun

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The hepatitis B virus (HBV) is an important human pathogen. Unvaccinated infants infected through mother-to-child transmission (MTCT) are at >95% risk of developing serum hepatitis B surface antigen-positive chronic hepatitis B (CHB). Despite complete passive-active HBV immunoprophylaxis, approximately 10% of infants born to mothers who are highly viremic develop CHB, and thus maternal treatment with nucleos(t)ide analogs (tenofovir disoproxil fumarate, lamivudine, or telbivudine) is recommended in the third trimester of pregnancy to reduce MTCT risk. Viral rebound usually occurs after stopping treatment and, in the context of maternal immunologic reconstitution postpartum, can also precipitate host immune-mediated hepatic (biochemical) flares. In this article, we review the epidemiology of HBV MTCT, discuss management and potential mechanisms of HBV vertical transmission, and highlight recent studies on virologic and immunologic aspects of hepatitis B in pregnancy and postpartum. (Hepatology Communications 2020;4:157-171).The global prevalence of CHB (serum HBsAg+) is 3.6%, with the highest prevalence in Africa (8.8%) and the Western Pacific (5.2%). More than 75% of individuals with CHB worldwide are found in the Asia Pacific

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Chronic HBV with pregnancy: Reactivation flare causing fulminant hepatic failure

Cited by 25 publications

References 19 publications

Case reports of latent HBV hepatitis in patients after neurosurgical treatment for hypothalamic and pituitary tumors

Case reports of latent HBV hepatitis in patients after neurosurgical treatment for hypothalamic and pituitary tumors

Hepatic failure in pregnancy successfully treated by online hemodiafiltration: Chronic hepatitis B virus infection without viral genome mutation

Hepatitis B and Pregnancy: Virologic and Immunologic Characteristics

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