Lamivudine treatment and outcome in pregnant women with high hepatitis B viral loads

Abstract

Perinatal transmission is the most common mode of hepatitis B virus (HBV) transmission and is a leading cause of chronic infection worldwide. Maternal treatment with lamivudine (LAM) can result in a rapid and significant reduction in HBV viral load (VL) and, thus, mitigate the risk of mother-to-child transmission (MTCT). The aim of this study was to retrospectively evaluate the safety of LAM treatment administered in the third trimester of pregnancy and determine the influence, if any, on infant outcome. The medical charts of all HBV surface antigen (HBsAg)-positive women eligible for treatment with LAM and who registered for antenatal care between 2007 and 2012 were retrospectively reviewed. During the 6-year period, 45 women met the criteria for LAM treatment. Thirty-six women (80 %) accepted treatment; the remaining women declined treatment (5), defaulted from care (3) or transferred to another maternity unit (1). The median duration of treatment was 11.4 weeks (range 5.3-17.4) and the median baseline VL was 1.4 × 10(8) IU/mL (range 1.8 × 10(7)-1.7 × 10(8)). The median VL at delivery was 2.3 × 10(5) IU/mL and 60 % of women achieved a VL reduction >2 log10 IU/mL before delivery. No cases of perinatal transmission occurred in the infants born to mothers who received treatment; however, one infant, born to a mother who defaulted from care, was HBV-infected at 8 months. The results suggest that LAM therapy in highly viraemic HBV-infected pregnant women could lower the rate of vertical transmission.

Comparative efficacy of antiviral therapy in preventing vertical transmission of hepatitis B: a network meta‐analysis

“…FDA considers it a pregnancy Category C medication with no evidence of teratogenecity in animals. In 2014, Jackson et al (28) published a study in which 45 women met criteria for LAM treatment, and no cases of perinatal transmission occurred in infants born to mothers who received treatment. The authors concluded that LAM therapy in highly viremic CHB-infected pregnant women could help reduce the rate of vertical transmission.…”

A Survey Study of Pregnant Women and Healthcare Practitioners Assessing the Knowledge of Attitudes and Practices of Hepatitis B Management at a Teaching Hospital in Kumasi, Ghana, West Africa

“…Hepatitis B virus MTCT is more likely to occur when the mother has high levels of detectable virus during pregnancy; antiviral therapy works by reducing the viral load in pregnant women, thus reducing the likelihood of transmission. Antiviral therapy has been highly effective at reducing human immunodeficiency virus transmission, and the drugs that could be used in HBV-infected pregnant women are both safe in pregnancy and affordable [ 5 , 7 ]. Furthermore, providing antiviral therapy to viremic women may be more feasible than the follow-up and administration of HBIG to newborns, especially in limited-resource environments.…”

Review of the Prevention of the Hepatitis B Virus Infection Transmission From Mother to Child During Pregnancy

“…There are many reports about the rate of the transmission of the HBV infection during pregnancy and also understanding of the mechanisms of the transmission of the infection from mother to child. All these studies have sought to implement policies on maternal screening and infant follow-up as well as mechanisms to minimize the transmission rate (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23). Here, we aimed to review the ways for the prevention of this infection from mother to child and research the new guidelines.…”

“…There is evidence that antiretroviral drugs such as Lamivudine, Tenofovir, and Telbivudine can prevent vertical transmission when administered to women with a high HBV viral load in the third trimester (23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38). It has been reported that mothers who have a viral load more than HBV DNA levels ≥ 10 6 copies/mL are at greatest risk for the transmission of the HBV to their infants.…”