Lamivudine treatment during pregnancy to prevent perinatal transmission of hepatitis B virus infection

Abstract

Vertical transmission of hepatitis B virus (HBV) can occur occasionally despite vaccination of the child. This vaccination breakthrough has been associated with high maternal viraemia. We treated eight highly viraemic (HBV-DNA >/= 1.2 x 10(9) geq/mL) mothers with 150 mg of lamivudine daily during the last month of pregnancy. HBV-DNA, hepatitis B surface antigen (HBsAg), anti-HBs and anti-HBc of their offspring were measured at birth and at 3, 6 and 12 months, respectively. Twenty-four children, born to untreated HBsAg-positive mothers with HBV-DNA levels >/=1.2 x 10(9) geq/mL served as historical controls. All children received passive-active immunization at birth and were followed-up for 12 months. In the lamivudine group one of the eight children (12.5%) was still HBsAg and HBV-DNA positive at the age of 12 months. All other children seroconverted to anti-HBs and maintained seroprotection. In three children, HBV-DNA was temporarily detected by polymerase chain reaction. In the untreated historical control group, perinatal transmission occurred in seven of 25 children (28%). In highly viraemic HBsAg-positive mothers, reduction of viraemia by lamivudine therapy in the last month of pregnancy may be an effective and safe measure to reduce the risk of child vaccination breakthrough. This approach should be evaluated in a large controlled trial.

Chronic hepatitis B in Asian women of childbearing age

“…For women who become pregnant while receiving oral NA therapy, current guidelines recommend continuing treatment if the drug is a category B drug such as telbivudine and tenofovir [34]. Emerging evidence suggests that the use of lamivudine in the last month of pregnancy might prevent mother-to-infant transmission of HBV in women with high HBV DNA levels [36][37][38][39][40].…”

“…The proposal to use oral antiviral agents to reduce maternal HBV DNA serum levels in the third trimester and immediate postnatal period to avoid mother-tonewborn transmission was evaluated in a pilot study using antiviral therapy, such as lamivudine, in the third trimester to reduce maternal serum HBV DNA level by the time of birth [37]. However, the trial did not yield convincing efficacy results.…”

“…Thus, the administration of oral antiviral therapy in the third trimester to women with CHB is controversial because there is no evidence to confirm a significant reduction in infection rates among infants and, more important, the safety of antiviral therapy in pregnant women is unproven. Withdrawal flare after delivery is an additional safety concern [37]. Antiviral therapy may not be available for mothers with CHB in developing regions where there is no healthcare system to oversee the administration of complicated management regimens.…”

24 year outcomes of hepatitis B vaccination in Hangzhou, China

“…Herd immunity induced by mass or nation-wide vaccination programs is well documented. [52][53][54] Preliminary studies have shown that lamivudine [55][56] and telbivudine 57 during pregnancy may reduce vertical transmission of HBV. Maternal to infant transmission may occur during the antenatal, intrapartum, or postnatal period.…”

Prevention of Hepatitis B

“…Continuing efforts are needed to prevent breakthrough infection of HBV by highly infectious mothers. Preliminary results using anti-HBV nucleoside analog during the last trimester of pregnancy to prevent mother-to-infant transmission have been reported (van Zonneveld et al 2003;Xu et al 2009;Han et al 2011). However, further studies are needed to determine the efficacy versus adverse responses and cost effectiveness in reducing mother-to-infant transmission from highly viremic mothers.…”