Efficacy and safety of continuous antiviral therapy from preconception to prevent perinatal transmission of hepatitis B virus

Exploring the impact of hepatitis B immunoglobulin and antiviral interventions to reduce vertical transmission of hepatitis B virus

Hepatitis B virus (HBV) infection is a major public health burden. In HBV endemic regions, high prevalence is also correlated with the infections acquired in infancy through perinatal transmission or early childhood exposure to HBV, the so-called mother-to-child transmission (MTCT). Children who are infected with HBV at a young age are at higher risk of developing chronic HBV infection than those infected as adults, which may lead to worse clinical outcome. To reduce the incidence of HBV MTCT, several interventions for the infants or the mothers, or both, are already carried out. This review explores the newest information and approaches available in literature regarding HBV MTCT prevalence and its challenges, especially in high HBV endemic countries. This covers HBV screening in pregnant women, prenatal intervention, infant immunoprophylaxis, and post-vaccination serological testing for children.

Oxidative Stress Induced by Antivirals: Implications for Adverse Outcomes During Pregnancy and in Newborns

Oxidative stress plays a critical role in various physiological and pathological processes, particularly during pregnancy, where it can significantly affect maternal and fetal health. In the context of viral infections, such as those caused by Human Immunodeficiency Virus (HIV) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), oxidative stress may exacerbate complications by disrupting cellular function and immune responses. Antiviral drugs, while essential in managing these infections, can also contribute to oxidative stress, potentially impacting both the mother and the developing fetus. Understanding the mechanisms by which antivirals can contribute to oxidative stress and examination of pharmacokinetic changes during pregnancy that influence drug metabolism is essential. Some research indicates that antiretroviral drugs can induce oxidative stress and mitochondrial dysfunction during pregnancy, while other studies suggest that their use is generally safe. Therefore, concerns about long-term health effects persist. This review delves into the complex interplay between oxidative stress, antioxidant defenses, and antiviral therapies, focusing on strategies to mitigate potential oxidative damage. By addressing gaps in our understanding, we highlight the importance of balancing antiviral efficacy with the risks of oxidative stress. Moreover, we advocate for further research to develop safer, more effective therapeutic approaches during pregnancy. Understanding these dynamics is essential for optimizing health outcomes for both mother and fetus in the context of viral infections during pregnancy.

Expert Consensus on the Prevention and Treatment of Chronic Hepatitis B in Children

The aim of this consensus is to standardize the prevention, diagnosis, and treatment of chronic hepatitis B in children and to achieve the goal of “eliminating viral hepatitis as a major public health threat by 2030” issued by the World Health Organization. Formulated by organized experts of the Chinese Society of Infectious Diseases and Chinese Society of Hepatology, Chinese Medical Association; Group of Infectious Diseases, Chinese Pediatric Society, Chinese Medical Association; and the National Clinical Research Center for Infectious Diseases (Beijing), the consensus provides the latest evidence and recommendations for the prevention, diagnosis, and treatment of chronic hepatitis B in children.

Chronic Hepatitis B in Women of Childbearing Age and Pregnant Women in China: A Cross-Sectional Study

Pregnant women and women of childbearing age were enrolled in our study and their knowledge about the Hepatitis B virus (HBV) and chronic hepatitis B (CHB) was evaluated. A questionnaire was distributed to every woman in the cross-sectional study. The questionnaire was answered by all participants before they received health education and advice about HBV and CHB from the doctors visited. Data collected from all answers were analyzed using the χ2 test and logistic regression models. A total of 206 pregnant women and women of childbearing age with CHB infection were enrolled in the study during their first visit to the Infectious Diseases Clinic of the Third Affiliated Hospital of Guangzhou Medical University. Some women of childbearing age (40.8%) and pregnant women with CHB infection (30.6%) still believed HBV could be transmitted through diet and/or mosquito bites. Some women of childbearing age and pregnant women with CHB infection had limited knowledge of the prevention of HBV transmission (111 of 206, 53.9%). Women with higher levels of education had more knowledge about HBV (senior middle school, P = 0.02; university, P <0.01). The majority of participants were willing to take antiviral medicine to decrease the mother-to-child transmission (MTCT) rate of HBV. Some women of childbearing age and/or pregnant women with CHB infection have relatively limited knowledge about HBV or CHB. This situation contributes to the timeliness, or lack thereof, of these women with CHB to see a doctor and receive antiviral therapy. As a result, the morbidity and mortality of HBV-related complications could increase along with the rate of MTCT of HBV.

Navigating Perinatal Challenges: A Comprehensive Review of Hepatitis B Viral Infection and Pregnancy Outcomes

Hepatitis B viral infection poses a significant challenge during pregnancy, as the risk of vertical transmission carries serious consequences for both maternal and neonatal well-being. This comprehensive review delves into the intricacies surrounding hepatitis B infection during the perinatal period, shedding light on its impact on pregnancy outcomes and stressing the necessity of addressing it within the broader framework of perinatal care. By scrutinizing current evidence, diagnostic methodologies, management techniques, and preventive measures, this review emphasizes the urgent need for enhanced screening protocols, timely interventions, and augmented public health initiatives. Notably, key findings underscore the elevated likelihood of chronic hepatitis B virus (HBV) infection in infants and its enduring implications for the health of both mothers and newborns. The imperative call to action advocates for a multifaceted approach, engaging healthcare professionals, policymakers, and public health agencies to optimize strategies for management and prevention, thereby striving for improved outcomes for pregnant women and their infants affected by hepatitis B viral infection.

Hepatitis B and C in Pregnancy and Children: A Canadian Perspective

In 2016, the World Health Organization released a plan to eliminate viral hepatitis as a public health threat by 2030. For Canada to achieve the recommended decreases in HBV- and HCV-related new diagnoses and deaths, an increase in services is urgently required. Identifying those at risk of, or who have acquired HBV and HCV, remains a challenge, especially with the emergence of new priority populations such as pregnant persons and children. Importantly, prenatal, and pediatric care are times when individuals are often already engaged with the healthcare system, leading to the potential for opportunistic or co-localized care and interventions. At present, Canada may not be maximizing all available virologic tools that could lead to increases in prevention, identification, improved management, or even cure. Here, we describe the continuum of care that includes preconception, prenatal, postpartum, and pediatric stages; and identify current global and Canadian recommendations, findings, and opportunities for improvement.

Efficacy and safety of tenofovir disoproxil fumarate or telbivudine used throughout pregnancy for the prevention of mother-to-child transmission of hepatitis B virus: A cohort study

OBJECTIVE

Tenofovir disoproxil fumarate (TDF) use compared with telbivudine (LdT) use throughout pregnancy has not been adequately investigated. To compare the efficacy and safety of TDF and LdT for the prevention of mother-to-child transmission (MTCT) of hepatitis B from highly viremic mothers throughout pregnancy in real-world settings.

STUDY DESIGN

This was a single-center, retrospective cohort study. From January 1, 2013, to December 31, 2018, we retrospectively enrolled 602 mothers with chronic hepatitis B (CHB) who received antiviral treatment throughout pregnancy at Beijing Ditan Hospital. A total of 562 mothers met the inclusion criteria, with 167 in the TDF group and 395 in the LdT group. Mothers and infants were followed for 28 weeks postpartum. The primary endpoint was the MTCT rate of HBV. The secondary endpoints were the safety profiles in mothers and infants.

RESULTS

The MTCT rates were 0 % in both the TDF and LdT groups. The rates of neonatal congenital abnormalities were similar between the TDF and LdT groups (1.2 % vs 1.8 %, P = 0.896). There were no significant differences in perinatal complications between the two groups (all P > 0.05). There were also no significant differences in gestational age or infant height, weight, Apgar score. The level of HBV DNA at 28 weeks postpartum was an independent risk factor for postpartum alanine aminotransferase (ALT) flares (OR = 2.348, 95 % CI: 1.100-5.016, P = 0.027).

CONCLUSION

TDF and LdT treatments throughout pregnancy in mothers with CHB were equally effective in preventing MTCT and safe.

Mother To Infant Transmission Of Hepatitis B Virus In The Face Of Neonatal Immunisation Is Not Necessarily Primary Vaccine Failure

BACKGROUND

Surveillance programmes undertaken in infants born to hepatitis B virus (HBV) infected mothers provide an opportunity to analyse virological markers from the neonate and early infancy. These data inform on mechanisms of HBV transmission and how available interventions can be better utilised for control of HBV infections arising at the mother/child interface.

METHODS

Retrospective analysis of HBV serological markers was undertaken in Dried Blood Spots collected from infants born to HBV-infected mothers. In addition, molecular analysis was performed in newborn blood spot cards, collected after birth, from infants identified as HBV-infected despite receiving prophylaxis.

RESULTS

Perinatal exposure could not account for all transmissions with at least one quarter (22%) of infants already infected in utero. All harboured a wild type HBsAg, with identical sequences noted in the neonatal and early infancy samples. In contrast, in infants infected perinatally (43%), selection of viruses harbouring amino acid changes in the HBsAg were common (80% of sequences) and divergent from the linked maternal sample.

CONCLUSION

Currently considered to represent vaccine failure, it is likely that a proportion of HBV infections result from in utero acquisition. These infections are unlikely to be susceptible to post-natal prophylaxis and current recommendations for maternal antiviral treatment may be too late to prevent transmission. Consideration should be given to the earlier use of antivirals during gestation to reduce the risk of intrauterine transmission together with completion of the immunisation schedule also to reduce the perinatal risk of HBV transmission.