Maternal viral load and hepatitis B virus mother‐to‐child transmission risk: A systematic review and meta‐analysis

Chen, Honglin; Zha, Man‐Li; Cai, Ji‐Yu; Qin, Gang

doi:10.1111/hepr.13072

Cited by 25 publications

(25 citation statements)

References 41 publications

(88 reference statements)

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“…HBV vaccination starting at birth is approximately 95% effective (10). Aside from host factors that may interfere with vaccine response (host genetics, immune status, etc), virological factors, such as maternal HBV DNA levels (>7 log 10 IU/mL; (11)) and HBeAg positivity, can have a significant impact on the risk of chronic infection in infants born to chronically infected mothers. Although reports have suggested the prevalence of HBsAg mutants are increasing, which may compromise the long-term success of vaccination programs (12), it has been repeatedly shown that mutations verified to result in immune escape, such as G145R, remain a rare exceptional cause of vaccine breakthrough, and that over time the HBsAg mutation frequency has not accelerated due to immunization (13).…”

Section: Discussionmentioning

confidence: 99%

Horizontal Transmission of Hepatitis B Virus From Mother to Child Due to Immune Escape Despite Immunoprophylaxis

Kanji

Penner

Giles

et al. 2019

J. pediatr. gastroenterol. nutr.

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Hepatitis B virus (HBV) vaccination starting at birth is approximately 95% effective in preventing mother-to-child transmission to infants born to HBV-infected mothers. A higher risk of transmission is associated with birth to a highly viremic mother, often due to transplacental exposure, while later horizontal transmission is much less common, particularly following complete vaccination. This study reports a case of infection in an older child despite appropriate immunoprophylaxis starting at birth and an apparent protective immune response post-vaccination. Two immune escape mutations within the antigenic determinant of the surface antigen-coding region were observed in the child's dominant HBV sequence, whereas the maternal HBV variant lacked mutations at both sites. Ultra-deep sequencing confirmed the presence of 1 mutation at low levels within the maternal HBV quasispecies population, suggesting early exposure to the child followed by viral evolution resulting in immunoprophylaxis escape and chronic infection.

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Section: Discussionmentioning

confidence: 99%

Horizontal Transmission of Hepatitis B Virus From Mother to Child Due to Immune Escape Despite Immunoprophylaxis

Kanji

Penner

Giles

et al. 2019

J. pediatr. gastroenterol. nutr.

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“…According to a deterministic mathematical transmission modelling study, approximately 210 million infants had been protected from HBV infection, owing to the application of the HBVac, by the year 2015 . However, the MTCT is more likely to occur in pregnant women with high viral load (HBV DNA > 10 6 IU/mL) and no antiviral treatment, even if both HBIG and HBVac immunizations have been applied, namely, interruption failure . Nucleo(t)side analogues (NAs), the most widely used orally administered agents against HBV, are expected to reduce the chance of vertical transmission via inhibiting the replication of maternal HBV.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of antiviral treatment on blocking the mother‐to‐child transmission of hepatitis B virus: A meta‐analysis

Song

Yang

Wang

et al. 2018

Journal of Viral Hepatitis

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Summary Nucleo(t)side analogues (NAs) have been administered as adjunctive therapy to interrupt the mother‐to‐child transmission (MTCT) of hepatitis B virus (HBV). The efficacy and safety of this method remain controversial. A meta‐analysis was conducted to evaluate the efficacy and safety of NAs treatment during pregnancy. The differences among different agents and initiation trimesters were analysed. A total of 9228 mother‐infant pairs in 59 studies (32 RCTs and 27 non‐RCTs) were included in this meta‐analysis. NAs significantly reduced the risk of MTCT, as indicated by seropositivity of hepatitis B surface antigen (HBsAg) (risk ratio (RR) = 0.51, 95% confidence interval (CI) 0.45‐0.57) and HBV DNA in newborns (RR = 0.22, 95% CI 0.18‐0.26). No differences in the efficacy of interrupting HBV MTCT were evident among lamivudine, telbivudine and tenofovir disoproxil fumarate. NA was more effective when administered from the second than from the third trimester as indicated by HBV DNA (RR: the second vs the third 0.08 vs 0.22, P = 0.010), but this effect was not evident as indicated by HBsAg (RR: the second vs the third 0.46 vs 0.53, P = 0.596). Antiviral treatment initiated from the second trimester did not confer a higher risk of safety problems in the newborns compared with treatment from the third trimester, as indicated by weight (P = 0.064), length (P = 0.491) and malformation rate (P = 0.635) of newborns. Conclusions Lamivudine, telbivudine and tenofovir disoproxil fumarate are equally effective in blocking HBV MTCT. Antiviral treatment can be applied from the second trimester, without obvious safety concerns.

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“…The Newcastle-Ottawa Scale (NOS) was used to assess the quality of the included observational studies. NOS involves a total of eight items divided into three categories: selection (4), comparability (1) and exposure (3). The scale ranges from zero to nine points.…”

Section: Risk Of Bias Assessmentmentioning

confidence: 99%

“…Chronic hepatitis B (CHB) remains a serious global public health issue [1][2][3][4][5] . According to data from the World Health Organization (WHO), an estimated 257 million people are infected with hepatitis B virus (HBV) 3 . Mother-to-child transmission (MTCT) is the major cause of CHB infection 3,6,7 .…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of antiviral therapy during the second or the third trimester for preventing mother-to-child hepatitis B virus transmission: a systematic review and meta-analysis

Yang

Zhong

Liao

et al. 2020

Rev. Inst. Med. trop. S. Paulo

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Maternal viral load and hepatitis B virus mother‐to‐child transmission risk: A systematic review and meta‐analysis

Abstract: Our meta-analysis indicated that maternal viral load was an important risk factor for MTCT in HBeAg-positive mothers, and maternal viral load was dose-dependent with HBV MTCT incidence.

Cited by 25 publications

References 41 publications

Horizontal Transmission of Hepatitis B Virus From Mother to Child Due to Immune Escape Despite Immunoprophylaxis

Horizontal Transmission of Hepatitis B Virus From Mother to Child Due to Immune Escape Despite Immunoprophylaxis

Efficacy and safety of antiviral treatment on blocking the mother‐to‐child transmission of hepatitis B virus: A meta‐analysis

Efficacy of antiviral therapy during the second or the third trimester for preventing mother-to-child hepatitis B virus transmission: a systematic review and meta-analysis

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