Enhancing interventions for prevention of mother-to-child- transmission of hepatitis B virus

Matthews, Philippa C.; Ocama, Ponsiano; Wang, Su; El-Sayed, Manal Hamdy; Turkova, Anna; Ford, Deborah; Torimiro, Judith; Ferreira, Ana Teresa; Miranda, Angélica Espinosa; Restrepo, Fernando De la Hoz; Seremba, Emmanuel; Mbu, Robinson Enow; Pan, Calvin Q.; Razavi, Homie; Dusheiko, Geoffrey; Spearman, C Wendy; Salehiniya, Hamid

doi:10.1016/j.jhepr.2023.100777

Cited by 16 publications

(10 citation statements)

References 134 publications

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“…The management of CHB centres on antiviral therapy, with the primary goal of suppressing viral replication, reducing liver inflammation, and preventing progression to cirrhosis and hepatocellular carcinoma. Lowering HBV viral load (VL) also reduces the risk of transmission; this is best exemplified by the use of prophylaxis for pregnant women at the highest risk of mother-to-child-transmission 2 .…”

Section: Introductionmentioning

confidence: 99%

A systematic review and meta-analysis of the risk of hepatitis B virus (HBV) genotypic resistance in people treated with entecavir or tenofovir

Lumley,

Delphin,

Mokaya

et al. 2023

Preprint

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BackgroundAs nucleos/tide analogue (NA) therapy for chronic Hepatitis B virus (HBV) infection becomes more widely indicated and available, understanding drug resistance is essential. We performed a systematic review and meta-analysis to estimate the risk of genotypic resistance to tenofovir and entecavir.MethodsWe searched nine databases up to 29-Aug-23. We included studies of HBV infection featuring >10 individuals, written in English, reporting tenofovir or entecavir treatment ≥48 weeks, with assessment of HBV genotypic resistance. Data were analysed according to prior exposure history to NA, and treatment with tenofovir or entecavir. Analyses were performed in R.Results62 studies involving a total of 12,358 participants were included. For tenofovir, pooled resistance risk was 0.0% at all time points, whether previously NA naive (11 studies; 3778 individuals) or experienced (19 studies; 2059 individuals). For entecavir, in treatment-naive individuals (22 studies; 4326 individuals), risk of resistance increased over time to 0.9% at ≥5 years (95%CI 0.1-2.3%). Entecavir resistance was increased in NA-experienced individuals (18 studies;1112 individuals), to 20.1% (95%CI 1.6-50.1%) at ≥5 years. There was a lack of consistent definitions, poor global representation and insufficient metadata to support subgroup analysis.DiscussionBased on existing data, tenofovir has an excellent resistance profile. More resistance is seen with entecavir, particularly in treatment-experienced groups. Due to data gaps, we may have under-estimated the true risk of resistance. Robust prospective data collection is crucial as treatment is rolled out more widely.

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Section: Introductionmentioning

confidence: 99%

A systematic review and meta-analysis of the risk of hepatitis B virus (HBV) genotypic resistance in people treated with entecavir or tenofovir

Lumley,

Delphin,

Mokaya

et al. 2023

Preprint

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“…The availability of effective preventive interventions, including active and passive infant immunization and peripartum antiviral maternal prophylaxis [ 7 ], underpins the effort to eliminate HBV as a major public health threat in the African region, with impact targets of reducing incidence of chronic HBV and HBV-related deaths by 90% and 65%, respectively by 2030 [ 8 ]. As part of the interventions for the PMTCT of HBV, the World Health Organization recommends early HBV screening for all pregnant women in settings with an HBV prevalence of ≥ 2% [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Barriers to hepatitis B virus screening of pregnant women in primary healthcare centers in Nigeria: health workers’ perspective

Olakunde,

Adeyinka,

Olakunde

et al. 2023

BMC Prim. Care

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Background Hepatitis B virus (HBV) screening is an important component of antenatal care for pregnant women in Nigeria. However, the screening rates remain low, particularly at primary healthcare centers (PHCs). The objective of this study was to identify the barriers affecting antenatal HBV screening in PHCs in Nigeria from the perspective of health workers. Methods We conducted a survey among 30 health workers from 30 PHCs (one per PHC) across three states (Akwa Ibom, Anambra, and Kaduna) in Nigeria. An open-ended questionnaire was used to obtain written responses on the perceived barriers limiting antenatal HBV screening in PHCs and their recommended solutions to the identified barriers. The data were analyzed using an inductive thematic approach. Results The perceived barriers exist at patient, provider and health system levels. They included: lack of test kits, unaffordability of HBV test, shortage of trained personnel, poor awareness among pregnant women, knowledge of HBV among health workers, high cost of antiviral treatment, and unavailability of HBV vaccine. The recommended solutions to the identified barriers were: making test kits and vaccines available and free, creating awareness about HBV, and capacity-building interventions for health workers. Conclusions HBV screening of pregnant women attending PHCs in Nigeria appears to be affected by multilevel barriers. As the country continues to work towards eliminating HBV, these highlighted barriers at the patient, provider and health system levels must be addressed through effective and sustainable interventions.

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“…We read with interest the article entitled “Enhancing interve-ntions for prevention-of-mother-to-child- transmission (PMTCT) of hepatitis B virus (HBV)” by Matthews et al. , 1 who comprehensively reviewed the measures for preventing MTCT of HBV. We consider that the proposals on the maternal administration of anti-HBV agents (nucleos(t)ide analogues [NAs]) to prevent MTCT of HBV should be viewed with caution.…”

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confidence: 99%

“…propose that maternal HBV DNA thresholds for antiviral prophylaxis may reduce from the current >2 × 10 5 (>200,000) IU/ml to ∼10 4 or even to 2 × 10 3 (>2,000), assuming that undetectable HBV DNA levels would mitigate any quantifiable transmission risk, based on the ‘undetectable = untransmissable’ (U U) paradigm for HIV. 1 However, HBV infection is different from HIV infection. All HIV-infected women, regardless of pregnancy, require antiretroviral therapy (ART), but most HBV-infected women at childbearing age are in an immunotolerant phase and do not require antiviral therapy.…”

mentioning

confidence: 99%

“…propose that maternal antiviral administration may start earlier in pregnancy, potentially as soon as maternal HBsAg-positive status is confirmed. 1 However, studies demonstrated that maternal administration of anti-HBV agents (including tenofovir disoproxil fumarate [TDF], and other anti-HBV agents) earlier than the third trimester did not further reduce MTCT of HBV. 2 , 3 In practice, after administration of antivirals in mothers with high viral loads and immunoprophylaxis in neonates, MTCT of HBV is almost completely blocked, [2] , [3] , [4] , [5] , [6] with MTCT rates as low as 0–<1% rather than 0–6%, which was mentioned in their article.…”

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confidence: 99%

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Does currently recommended maternal antiviral prophylaxis against mother-to-child transmission of hepatitis B virus require enhancement?

Zhou

2023

JHEP Reports

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Enhancing interventions for prevention of mother-to-child- transmission of hepatitis B virus

Cited by 16 publications

References 134 publications

A systematic review and meta-analysis of the risk of hepatitis B virus (HBV) genotypic resistance in people treated with entecavir or tenofovir

A systematic review and meta-analysis of the risk of hepatitis B virus (HBV) genotypic resistance in people treated with entecavir or tenofovir

Barriers to hepatitis B virus screening of pregnant women in primary healthcare centers in Nigeria: health workers’ perspective

Does currently recommended maternal antiviral prophylaxis against mother-to-child transmission of hepatitis B virus require enhancement?

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