Systematic review with meta‐analysis: the efficacy and safety of tenofovir to prevent mother‐to‐child transmission of hepatitis B virus

Hyun, Myung Han; Lee, Young‐Sun; Kim, Ji H.; Je, Jacobson; Yoo, Yang Jae; Yeon, Jong Eun; Byun, Kwan Soo

doi:10.1111/apt.14068

Cited by 72 publications

(82 citation statements)

References 61 publications

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“…This low birth dose coverage is problematic as those infections acquired at birth in Sub‐Saharan Africa are the ones that account for the majority of chronic liver disease later in life . New tools are becoming available to prevent transmission of HBV from mothers to children, including use of Tenofovir for mothers with high viral load . Further examination of evidence, values and preferences is needed before WHO can make a decision to recommend them for large‐scale use.…”

Section: Discussionmentioning

confidence: 99%

How far are we from viral hepatitis elimination service coverage targets?

2018

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IntroductionIn 2016, the Global Health Sector Strategy (GHSS) on viral hepatitis called for elimination of viral hepatitis as a major public health threat by 2030 (i.e. 90% reduction in incidence and 65% in mortality). In 2017, WHO's first‐ever Global Hepatitis Report presented the baseline values for each of the core indicators of the strategy. We review the challenges and opportunities that lie ahead in order to reach the 2030 service coverage targets.DiscussionThree‐dose coverage of hepatitis B vaccine in infancy reached 84% in 2015 (2030 target: 90%); however, only 39% received the timely birth dose (2030 target: 90%). Blood safety (97% of blood units screened with quality assurance, 2030 target: 100%) and injection safety (5% unsafe injections, 2030 target: 0%) had made substantial progress while harm reduction fell short (27 syringe and needle sets distributed per person who injects drugs per year, 2030 target: 300). Worldwide, 9% and 20% of the HBV‐ and HCV‐infected population respectively, were aware of their status (2030 targets: 90%). In the short term, to reach the 2020 target of diagnosing 50% of those infected, 107 million HBV infected persons and 15 million HCV infected persons should be urgently diagnosed. Overall, in 2015, less than 10% of known infected persons were on HBV treatment or had started HCV treatment (2030 targets: 80%).ConclusionsThe prevention component of elimination is on track with respect to hepatitis B vaccination, blood safety, and injection safety. However, coverage of the hepatitis B vaccine timely birth dose requires a substantial increase, particularly in sub‐Saharan Africa, and harm reduction needs to be taken to scale as injecting drug use accounts for a third of mortality from HCV infection. A promising but limited start in hepatitis testing and treatment needs to be followed by immediate and sustained action so that we reach the service coverage targets required to achieve elimination by 2030. Treating persons coinfected with HIV and hepatitis viruses is particularly urgent and needs to be promoted in the context of the HIV response.

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Section: Discussionmentioning

confidence: 99%

How far are we from viral hepatitis elimination service coverage targets?

2018

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“…There are additional tools that can be added to infant hepatitis B vaccination that are effective to prevent HBV MTCT: (a) timely administration of birth dose vaccination (BDV), as defined as, the administration of the first dose of hepatitis B vaccine to babies as soon as possible after birth, preferably within 24 hours; (b) hyperimmune hepatitis B immunoglobulin (HBIG) to babies; and (c) more recently, antiviral therapy for HBV‐infected pregnant mothers with high risk of infants’ immunoprophylaxis failure despite receiving BDV and HBIG . However, the coverage of these interventions is globally highly heterogeneous, with data from a recent study by the Polaris group suggesting that in 2016 only 46% of infants received timely BDV, 13% of infants born to HBsAg‐positive mothers received HBIG and completed a series of hepatitis B vaccinations including BDV, and <1% of mothers with high viral load received antiviral treatment …”

Section: Interventions To Prevent Mother‐to‐child Transmission Of Hbvmentioning

confidence: 99%

Mother‐to‐child transmission of hepatitis B: What more needs to be done to eliminate it around the world?

Nayagam

Shimakawa

Lemoine

2020

Journal of Viral Hepatitis

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Mother‐to‐child transmission (MTCT) of hepatitis B virus (HBV) is a key component of the hepatitis B burden worldwide. Despite its efficacy to prevent HBV transmission, infant vaccination is not enough to control HBV MTCT. Additional efforts are urgently needed to evaluate and scale‐up preventive strategies especially in endemic countries, which are most affected. This review highlights the efficacy and barriers of the currently validated measures for the prevention of HBV MTCT and proposes alternatives adapted to resource‐limited settings to eventually achieve HBV elimination worldwide.

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“…Available data suggest that beginning treatment for HBV in the third trimester (around 28‐32 weeks of gestation) may be sufficient to prevent mother‐to‐child transmission of HBV in the latter group . Although lamivudine, telbivudine or TDF prophylaxis has been used, TDF is now considered to be the best option . The duration of NAs therapy for the prevention of perinatal transmission has not been well defined, but it is usually advised to continue treatment until 12 weeks after delivery .…”

Section: Treatment Indicationsmentioning

confidence: 99%

“…4 Although lamivudine, telbivudine or TDF prophylaxis has been used, TDF is now considered to be the best option. 4,32,33 The duration of NAs therapy for the prevention of perinatal transmission has not been well defined, but it is usually advised to continue treatment until 12 weeks after delivery. 4 Although HBsAg can be detected in breastmilk, breastfeeding is not contraindicated in HBsAg-positive mothers.…”

Section: Pregnancymentioning

confidence: 99%

Hepatitis B: Who and when to treat?

Vlachogiannakos

Papatheodoridis

2018

Liver International

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As current treatment options almost never achieve eradication of hepatitis B virus (HBV), the most realistic goal for HBV treatment is persistent inhibition of viral replication and ALT normalization. Thus, the decision to start treatment should be based on careful patient selection and individualized decisions. Treatment is generally indicated in chronic hepatitis B patients with HBV DNA >2000 IU/mL, elevated ALT and/or at least moderate histological lesions, while all patients with cirrhosis and detectable HBV DNA should be treated. Patients with HBV DNA >20 000 IU/mL and ALT >2xULN (upper limit of normal), HBV DNA >2000 IU/mL and liver stiffness >9 or >12 kPa in case of normal or ≤5xULN, HBV DNA >2000 IU/mL and a family history of cirrhosis and/or HCC as well as HBeAgpositive patients with HBV DNA >20 000 IU/mL and over 30 years old can begin treatment whatever the liver histology. Moreover, patients with HBV DNA >2000 IU/mL and at least moderate histological lesions can begin treatment whatever the ALT levels. This review describes the current therapeutic indications for chronic HBV infection, including the natural history of the disease, the realistic goals of therapy and the specific patient subgroups that require treatment. | NATURAL HISTORY: FROM CHRONIC HBV INFECTION TO HEPATOCELLULAR CARCINOMAThe natural history of chronic HBV infection is determined by a complex relationship between the virus and the host immune system. It has been schematically divided into five phases whose durations vary, distinguished by the presence of the hepatitis Be antigen (HBeAg) orAbbreviations: ALT, alanine aminotransferase; CHB, chronic hepatitis B; HBV, hepatitis B virus; HCC, hepatocellular carcinoma; NA, nucleos(t)ide analogue; Peg-IFNa, pegylated interferon-alpha; TDF, tenofovir disoproxil fumarate; ULN, upper limit of normal.

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Systematic review with meta‐analysis: the efficacy and safety of tenofovir to prevent mother‐to‐child transmission of hepatitis B virus

Cited by 72 publications

References 61 publications

How far are we from viral hepatitis elimination service coverage targets?

How far are we from viral hepatitis elimination service coverage targets?

Mother‐to‐child transmission of hepatitis B: What more needs to be done to eliminate it around the world?

Hepatitis B: Who and when to treat?

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