Chronic hepatitis B in pregnant women: is hepatitis B surface antigen quantification useful for viral load prediction?

Abstract

HBsAg levels provide a good viral load predictor in HBeAg-positive but not HBeAg-negative pregnant women. The HBeAg-negative group had a frequent occurrence of BCP/PC variants, which may have contributed to the lack of correlation observed. Samples with a low HBsAg level, which is associated with a low risk of MTCT, do not require HBV DNA measurement.

Mother‐to‐child transmission of hepatitis B: Examining viral cut‐offs, maternalHBsAg serology and infant testing

“…Untreated infection may lead to hepatocellular carcinoma or death from liver‐related sequelae in 15%‐45% of those affected. CHB is usually the result of mother‐to‐child transmission (MTCT) because of impaired immunological response and clearance . Despite immune prophylaxis, up to 10% of babies from mothers with high viral loads (HVL) acquire HBV thus antepartum antiviral therapy (AVT) is recommended to reduce this .…”

“…In that study, a HBsAg value >4.1 log 10 IU/mL had sensitivity 100% and specificity 71.3% for predicting transmission. Quantitative HBsAg levels have thus been proposed as an alternative to identifying women with a high risk for MTCT in recent EASL guidelines . Data remain limited for such firm conclusions.…”

“…Data remain limited for such firm conclusions. The correlation is imperfect in other settings for reasons that may include variation with HBV genotype …”

“…The presence of HBeAg is a marker of high viral replication, and may have a role in predicting risk of MTCT and need for AVT . Mechanistically, HBeAg is transferred across the placenta and may influence fetal immunotolerance .…”

“…CHB is usually the result of mother-to-child transmission (MTCT) because of impaired immunological response and clearance. [2][3][4][5][6][7][8] Despite immune prophylaxis, up to 10% of babies from mothers with high viral loads (HVL) acquire HBV thus antepartum antiviral therapy (AVT) is recommended to reduce this. 2,4,5,[9][10][11][12][13][14][15] The risk to the infant from AVT is expected to be small, although decreased bone mineral density in tenofovir disoproxil fumarate (TDF)-exposed infants (of HIV positive mothers) has been reported, and longer term follow-up of exposed infants is limited.…”