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Li EM, Xiao LX, Xu Z, Mo ZS, Li JQ, Mei YY, Lin CS. Factors associated with non-compliance with breastfeeding recommendation: a retrospective survey in hepatitis B virus-infected mothers who had taken Nucleos(t)ide analogs during pregnancy. BMC Pregnancy Childbirth 2021; 21:551. [PMID: 34384374 PMCID: PMC8359301 DOI: 10.1186/s12884-021-04020-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 07/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We encourage Hepatitis B virus-infected mothers to breastfeed postpartum, even when continuing pregnancy category B nucleos(t)ide analogs (NAs) treatment. However, a large proportion of the Hepatitis B virus-infected mothers were noncompliant with this breastfeeding recommendation. This study aimed to investigate the factors associated with noncompliance with breastfeeding recommendation in Hepatitis B virus-infected mothers who had received NAs treatment during pregnancy. METHODS A total of 155 mothers with chronic hepatitis B receiving NAs treatment for preventing mother-to-child transmission during the late gestation period were included and divided into exclusive breastfeeding (n = 63), mixed feeding (n = 34), and artificial feeding (n = 58) groups according to the postpartum feeding methods. Independent variables associated with feeding methods were analyzed using logistic regression analysis. RESULTS Compared to the breastfeeding and mixed feeding groups, the artificial feeding group had significantly more multiparity, later postpartum timing of stopping NAs treatment, and a lower proportion of having knowledge of NAs medications (all P < 0.05). In addition, multivariable logistic regression analysis confirmed that multiparity, later postpartum timing of stopping NAs treatment, and lacking knowledge of medication were independent factors associated with noncompliance with breastfeeding recommendation. CONCLUSIONS Hepatitis B virus-infected mothers who stopped NAs treatment at late postpartum period or had less knowledge of medication were more likely to be noncompliant with breastfeeding recommendation. Strengthening health education for participants taking NAs may be an important method to improve compliance with breastfeeding recommendation.
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Affiliation(s)
- Er-Mei Li
- Department of Infectious Diseases, the Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangdong Province, 510630, Guangzhou, China
| | - Li-Xin Xiao
- Department of Infectious Diseases, the Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangdong Province, 510630, Guangzhou, China
| | - Zhen Xu
- Department of Infectious Diseases, the Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangdong Province, 510630, Guangzhou, China
| | - Zhi-Shuo Mo
- Department of Infectious Diseases, the Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangdong Province, 510630, Guangzhou, China
| | - Jia-Qian Li
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 510120, Guangzhou, China
| | - Yong-Yu Mei
- Department of Infectious Diseases, the Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangdong Province, 510630, Guangzhou, China.
| | - Chao-Shuang Lin
- Department of Infectious Diseases, the Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangdong Province, 510630, Guangzhou, China.
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2
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Yi W, Cao X, Zeng Z, Cao W, Zhang Y, Sun F, Wang Y, Wan G, Li M, Xie Y. Developmental consequences of children born from mothers with telbivudine treatment during late pregnancy: A prospective study with 3-year follow-up. Virulence 2021; 12:1527-1537. [PMID: 34120564 PMCID: PMC8205043 DOI: 10.1080/21505594.2021.1936769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
We prospectively investigated the neurological development in infants born from mothers treated with telbivudine (LdT) in the third trimester for prevention of hepatitis B virus (HBV) mother-to-infant transmission. Mothers with high HBV load were assigned to either the LdT group (n = 81, 600 mg of LdT each day from gestational week 28 to delivery) or the Control group (n = 39, untreated). Their infants were followed for 36 months to assess physical and neurological developments with Gesell Developmental Schedule tools. At 12 months after birth, the mean scores in the LdT group for gross motor, fine motor, adaptive, linguistic, and personal social domains were similar to those in the Control group. At 36 months, infants in the LdT group had higher mean scores for gross motor than the Control group (98.42 ± 9.69 vs. 94.54 ± 7.48, P = 0.03). In the LdT group, the rates of normal development were higher for gross motor (96.30% vs. 82.05% P = 0.01) and lower for adaptive (74.07% vs. 92.31% P = 0.02). Multivariate regression analyses showed that exposure to LdT during pregnancy was independently associated with infant’s development in gross motor (OR 6.49, 95% CI 1.37–30.20, P = 0.02) and adaptive (OR 0.18, 95% CI 0.05–0.71, P = 0.01) at 36 months. These results suggest that prenatal LdT exposure might affect neurological development in long-term observation. Abbreviations: LdT: telbivudine; HBV: hepatitis B virus; HBsAg: hepatitis B surface antigen; HBeAg: hepatitis Be antigen; HbsAb: hepatitis B surface antibody; ALT: alanine aminotransferase; NA: nucleoside/nucleotide analog; LAM: lamivudine; MTCT: mother-to-child transmission; GDS: Gesell Developmental Schedule; OR: odds ratio; CI: confidence interval; DQ: developmental quotient; RMB: renminbi; BMI: body mass Index; HBIG: hepatitis B immunoglobulin.
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Affiliation(s)
- Wei Yi
- Department of Gynecology and Obstetrics, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Xiuzhen Cao
- Department of Gynecology and Obstetrics, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Zhan Zeng
- Department of Hepatology Division 2, Peking University Ditan Teaching Hospital, Beijing, China
| | - Weihua Cao
- Department of Hepatology Division 2, Peking University Ditan Teaching Hospital, Beijing, China
| | - Ying Zhang
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Fangfang Sun
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Ying Wang
- Department of Child Health Care, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Gang Wan
- Medical Records and Statistics Room, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Minghui Li
- Department of Hepatology Division 2, Peking University Ditan Teaching Hospital, Beijing, China.,Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yao Xie
- Department of Hepatology Division 2, Peking University Ditan Teaching Hospital, Beijing, China.,Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
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3
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Efficacy of Nucleotide/Nucleoside Analogues and Hepatitis B Immunoglobulin Therapy in Blocking Mother-to-Child Transmission of Hepatitis B in an Eastern Chinese Group. Infect Dis Obstet Gynecol 2020; 2020:4305950. [PMID: 33380780 PMCID: PMC7759418 DOI: 10.1155/2020/4305950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 10/19/2020] [Accepted: 11/24/2020] [Indexed: 11/24/2022] Open
Abstract
The objective of this study was to investigate the efficacy and potential side-effects of nucleotide/nucleoside analogues and hepatitis B immunoglobulin injection of newborns in blocking mother-to-child transmission of hepatitis B virus in the middle and late pregnancy period. 238 cases of enrolled pregnant women were divided into the Telbivudine group, the Tenofovir group, the Lamivudine group, and the hepatitis B immunoglobulin (HBIG) group. Enrolled patients received corresponding therapies. Clinical and laboratory data were collected. Results showed that the levels of HBV DNA of the enrolled pregnant women in the Telbivudine, Tenofovir, and Lamivudine groups decreased rapidly after 12 weeks of drug intervention compared with those in the control. HBsAg positive rate in newborns and in children 24 weeks after birth was 0/60, 0/60, 0/60, 3/30, and 11/28 in the Telbivudine, Tenofovir, Lamivudine, HBIG, and control groups, respectively. No significant side-effects were identified after following up to 12 months after birth. Our results show that routine HBV vaccine plus HBIG injections is insufficient in blocking mother-to-child HBV transmission. Administration of nucleotide/nucleoside analogues or HBIG at pregnancy is suggested to maximize the blocking of vertical HBV transmission.
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4
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Efficacy and Safety of Tenofovir in the Prevention of Perinatal Transmission of Hepatitis B, a Meta-Analysis. GASTROENTEROLOGIA Y HEPATOLOGIA 2020; 43:640-648. [PMID: 32948358 DOI: 10.1016/j.gastrohep.2020.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 02/23/2020] [Accepted: 03/31/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND Tenofovir disoproxil fumarate (TDF) is recommended for the prevention of perinatal transmission of the hepatitis B virus (HBV). This study aimed to systematically assess the efficacy and safety of TDF in pregnant women with chronic HBV and their infants. MATERIAL AND METHODS Database searches were performed to identify studies blocking the mother-to-child transmission of the hepatitis B virus with tenofovir. The search included pregnant women with chronic HBV infection administered with TDF compared to the no treatment controls, and data from individual studies were pooled using RevMan v5.3 for meta-analysis. RESULTS Seven studies with a total of 911 patients met the inclusion criteria: 433 patients in the TDF group and 478 patients in the non-TDF group. The HBV mother-to-child transmission rate in the tenofovir group was effectively reduced compared to the control group (RR: 0.18, 95% CI: 0.08-0.40). HBV-DNA positivity was also significantly low in infants from TDF group (RR: 0.17, 95% CI: 0.10-0.30) and the TDF treatment resulted in significantly higher anti-HBs production (RR: 1.11, 95% CI: 1.04-1.18). Similarly, maternal HBV-DNA was suppression was significantly high in the TDF group (RR: 34.16, 95% CI: 16.40-71.13). Women treated with TDF and their infants did not result in serious adverse events that are statistically different as compared to the women who did not receive any treatment. CONCLUSION Treatment of HBV infected pregnant women with TDF can effectively and safely prevent the perinatal transmission of chronic hepatitis B.
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5
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Liu J, Wang J, Yan T, Du D, Qi C, Cao F, Yao N, Yang Y, He Y, Tian Z, Ren D, Zhu L, Chen T, Zhao Y. Efficacy and safety of telbivudine and tenofovir disoproxil fumarate in preventing hepatitis B vertical transmission: A real-life practice. J Viral Hepat 2019; 26:1170-1177. [PMID: 31177596 DOI: 10.1111/jvh.13156] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/17/2019] [Accepted: 05/08/2019] [Indexed: 12/12/2022]
Abstract
Mother-to-child transmission (MTCT) is a major obstacle in the elimination of hepatitis B virus (HBV) infection. Telbivudine (LdT) and tenofovir disoproxil fumarate (TDF) are the two most common antiviral medicines for preventing MTCT. However, the efficacy and safety of LdT and TDF in preventing HBV vertical transmission during the second to third trimester have not been compared rigorously. Therefore, we carried out a prospective multicentre cohort study of chronic hepatitis B in mothers with HBV DNA > 106 IU/mL, receiving LdT or TDF during the second to third trimester. Among the 893 mothers enrolled, 857 (LdT/TDF/untreated group (NTx) = 396/325/136) completed consecutive follow-up with 854 infants (LdT/TDF/NTx = 395/323/136). LdT and TDF treatment resulted in a similar decrease of HBV DNA in mothers at delivery. Multivariate analysis indicated that only HBsAg titre at the baseline correlated with viral DNA decrease (P = 0.015). With intention-to-treat analysis, MTCT rates in the LdT, TDF and NTx group were 4.41%, 2.42% and 22.08%, respectively. An increasing vertical transmission rate was found to be closely associated with higher HBsAg titre, 5.32% and 17.65% infection rate was estimated in infants born to mothers with HBsAg > 4 and >5 log10 IU/mL, respectively. No serious side effects were reported in either mothers or infants. LdT and TDF treatments were well tolerated and showed comparable efficacy in reducing MTCT. Higher risk of MTCT was shown in pregnant women with HBsAg > 4 log10 IU/mL.
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Affiliation(s)
- Jinfeng Liu
- Department of Infectious Diseases, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Jing Wang
- Department of Rheumatology and Immunology, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Taotao Yan
- Department of Infectious Diseases, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Dan Du
- Department of Infectious Diseases, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Caijing Qi
- Department of Gynecology and Obstetrics, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Furong Cao
- Department of Neonatology, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Naijuan Yao
- Department of Infectious Diseases, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Yuan Yang
- Department of Infectious Diseases, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Yingli He
- Department of Infectious Diseases, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Zhen Tian
- Department of Infectious Diseases, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Danfeng Ren
- Department of Infectious Diseases, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Li Zhu
- Department of Infectious Diseases, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Tianyan Chen
- Department of Infectious Diseases, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Yingren Zhao
- Department of Infectious Diseases, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
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6
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Han LF, Zheng JM, Zheng LQ, Gao HB, Chen LX, Xu QL, Chai YH, Zhang X, Pan C, Yao LF. Telbivudine can safely reduce mother-to-child transmission in chronic hepatitis B women after 12 weeks of gestation. BMC Infect Dis 2019; 19:614. [PMID: 31299917 PMCID: PMC6626355 DOI: 10.1186/s12879-019-4250-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 07/03/2019] [Indexed: 12/12/2022] Open
Abstract
Background To evaluate the efficacy and safety of telbivudine in chronic hepatitis B women during the second and third trimesters of pregnancy. Methods The week 12–34 of pregnant women were screened in this prospective non-intervention study, with HBV DNA > 106 IU/mL and alanine aminotransferase > 50 IU/L. The patients were received telbivudine treatment as a treatment group or without antiviral treatment as a control group. All infants were received recombinant hepatitis B vaccine 10 μg within 12 h of birth, at week 4 and week 24, immunoglobulin G within 12 h of birth and were detected HBV markers at the range from 7 to 12 months after delivery. Results A total of 241 patients were finally enrolled, 139 patients in telbivudine group and 102 patients in control group. HBsAg negative rate of infants was 99.3% (135/136) in telbivudine group and was 91.9% (91/99) in control group after 7 months (P = 0.005), respectively. The incidence of undetectable HBV DNA levels (47.5%) was significantly lower in telbivudine-treated mothers than that in the controls (0%), and 75.5% patients alanine aminotransferase returned to normal in telbivudine group, and 51% in control group at delivery (P < 0.001), respectively. Conclusions Telbivudine can safely reduce mother-to-child transmission in chronic hepatitis B women after 12 weeks of gestation.
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Affiliation(s)
- Li-Fen Han
- Department of Liver Diseases, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, 350025, China
| | - Jian-Ming Zheng
- Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Li-Qing Zheng
- Department of Liver Diseases, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, 350025, China
| | - Hai-Bing Gao
- Department of Liver Diseases, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, 350025, China
| | - Li-Xia Chen
- Department of Liver Diseases, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, 350025, China
| | - Qing-Ling Xu
- Department of Liver Diseases, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, 350025, China
| | - Yi-Hong Chai
- Department of Liver Diseases, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, 350025, China
| | - Xin Zhang
- Department of Liver Diseases, The Second Hospital of Longyan, Fuzhou, 350025, China
| | - Chen Pan
- Department of Liver Diseases, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, 350025, China
| | - Lv-Feng Yao
- Department of Liver Diseases, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, 350025, China.
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7
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Jourdain G, Ngo-Giang-Huong N, Khamduang W. Current progress in the prevention of mother-to-child transmission of hepatitis B and resulting clinical and programmatic implications. Infect Drug Resist 2019; 12:977-987. [PMID: 31118703 PMCID: PMC6499137 DOI: 10.2147/idr.s171695] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 03/25/2019] [Indexed: 12/14/2022] Open
Abstract
There is currently no cure for hepatitis B chronic infections. Because new hepatitis B infections result mainly from perinatal transmission, preventing mother-to-child transmission is essential to reach by 2030 the goal of hepatitis B elimination set by the World Health Organization. The universal administration of hepatitis B vaccine to all infants, regardless of maternal status, starting with the birth dose, is the cornerstone of the strategy for elimination. Additional interventions, such as hepatitis B immune globulin administered to newborns and antiviral prophylaxis administered to hepatitis B infected pregnant women, may contribute to reaching the goal earlier. Hepatitis B immune globulin may remain out for reach of many pregnant women in low- and middle-income countries due to cost and logistic issues, but antivirals are cheap and do not require a cold chain for distribution. However, it has been observed that some viruses harbor mutations associated with escape from vaccine-elicited antibodies following immunization or administration of hepatitis B immune globulin. Also, resistance associated mutations have been described for several drugs used for treatment of hepatitis B infected patients as well as for the prevention of mother-to-child transmission. Whether these mutations have the potential to compromise the prevention of mother-to-child transmission or future treatment of the mother is a question of importance. We propose a review of important recent studies assessing tenofovir disoproxil fumarate for the prevention of mother-to-child transmission, and provides detailed information on the mutations possibly relevant in this setting.
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Affiliation(s)
- Gonzague Jourdain
- Unit 174-PHPT, Institut de recherche pour le développement (IRD), Marseille, France.,Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand.,Department of Immunology and Infectious Diseases, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Nicole Ngo-Giang-Huong
- Unit 174-PHPT, Institut de recherche pour le développement (IRD), Marseille, France.,Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand.,Department of Immunology and Infectious Diseases, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Woottichai Khamduang
- Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
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8
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Sarpel D, Kushner T, Carter D, Huisman T, Chiu S, Dieterich D. Mother-to-child transmission of hepatitis B and C virus: review of the epidemiology and current treatment options. Future Virol 2018. [DOI: 10.2217/fvl-2017-0069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Hepatitis B and C viruses are the leading causes of liver-related morbidity and mortality throughout the world. Hepatitis B virus is predominantly transmitted perinatally, particularly in endemic areas. The rate of mother-to-child transmission of hepatitis C virus is on the rise, largely due to the increasing opioid epidemic. While there are guidelines established for the screening and treatment of pregnant females at risk for chronic hepatitis B infection, there no such guidelines or treatment options available in pregnant females with chronic hepatitis C infection. This review examines the epidemiology of mother-to-child transmission of chronic hepatitis B and C as well as the current treatment options during pregnancy and breastfeeding for both.
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Affiliation(s)
- Dost Sarpel
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai West/St Luke's Campus, 1000 10th Avenue, Clinic 2T, New York, NY 10019, USA
| | - Tatyana Kushner
- Department of Medicine, Institute of Liver Medicine, Icahn School of Medicine at Mount Sinai, Annenberg 5–04, 1468 Madison Ave Box 1123, New York, NY 10029, USA
| | - Danielle Carter
- Department of Medicine, Institute of Liver Medicine, Icahn School of Medicine at Mount Sinai, Annenberg 5–04, 1468 Madison Ave Box 1123, New York, NY 10029, USA
| | - Tsipora Huisman
- Department of Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Place, New York, NY 10029, USA
| | - Sophia Chiu
- Department of Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Place, New York, NY 10029, USA
| | - Douglas Dieterich
- Department of Medicine, Institute of Liver Medicine, Icahn School of Medicine at Mount Sinai, Annenberg 5–04, 1468 Madison Ave Box 1123, New York, NY 10029, USA
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9
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Liu J, Chen T, Zhao Y. Telbivudine therapy for gravidas with chronic hepatitis B infection and patients at risk of renal impairment. J Viral Hepat 2017; 24 Suppl 1:6-11. [PMID: 29082653 DOI: 10.1111/jvh.12787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 08/24/2017] [Indexed: 12/12/2022]
Abstract
Hepatitis B virus infection is currently the most important cause of chronic viral hepatitis worldwide and is one of the most frequent causes of end-stage liver disease. With the international implementation of the hepatitis B vaccine and combined prophylaxis for infants born to HBsAg(+) mothers, the prevalence of hepatitis B has decreased remarkably. However, intra-uterine transmission has become a critical bottleneck for eliminating hepatitis B infection. The efficacy of nucleos(t)ide analogs on inhibiting hepatitis B replication has been widely confirmed, and the quality of life and the survival of individuals with chronic hepatitis B (CHB) have improved to a great degree. However, with the availability of long-term antiviral treatment and the ever increasing ageing population, renal disorders should be considered when choosing antiviral medicines. The antiviral efficacy and safety of telbivudine (LdT) have been shown in patients with CHB infection, and LdT is approved as a class B drug for pregnancy. Furthermore, the renal protective function of LdT has been demonstrated recently. In this review, we will focus on the efficacy and safety of LdT in gravidas with CHB infection, as well as the renal protective function of LdT in CHB patients. LdT might provide physicians with a solid option for effectively treating patients with CHB, especially gravidas or those either with or at risk of renal impairment.
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Affiliation(s)
- J Liu
- Department of Infectious Disease, the First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China.,Institution of Hepatitis, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - T Chen
- Department of Infectious Disease, the First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China.,Institution of Hepatitis, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Y Zhao
- Department of Infectious Disease, the First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China.,Institution of Hepatitis, Xi'an Jiaotong University, Xi'an, Shaanxi, China
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10
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Jaffe A, Brown RS. A Review of Antiviral Use for the Treatment of Chronic Hepatitis B Virus Infection in Pregnant Women. Gastroenterol Hepatol (N Y) 2017; 13:154-163. [PMID: 28539842 PMCID: PMC5439134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Mother-to-child transmission (MTCT) of hepatitis B virus (HBV) remains high even with the proper use of active-passive immunoprophylaxis in newborns. Mothers with significant viremia are at a much higher risk of MTCT; therefore, treatments aimed at lowering HBV DNA levels during pregnancy may ultimately decrease global disease burden. The exact threshold for treatment remains controversial; however, most studies have accepted levels greater than 2 × 5 log10 IU/mL as significant viremia. We reviewed the most recent literature on antiviral efficacy, maternal and fetal safety, and viral resistance patterns when used for short-duration therapy in pregnancy. The literature review shows that antiviral therapy during pregnancy significantly reduces maternal HBV DNA levels with subsequent reductions in infant HBV infections. Tenofovir disoproxil fumarate (TDF) is associated with mild gastrointestinal distress and may cause decreased fetal bone growth (although long-term studies are needed to evaluate the clinical significance of this finding), and the impact of this drug is likely limited when use is restricted to the third trimester. Lamivudine and telbivudine remain inferior to TDF in regard to resistance profiles. Overall, TDF, lamivudine, and telbivudine in conjunction with standard immunoprophylaxis are recommended for use in pregnant women with significant HBV viremia (>2 × 5 log10 IU/mL) to prevent MTCT and appear reassuring in regard to their maternal and fetal safety profiles.
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Affiliation(s)
- Ariel Jaffe
- Dr Jaffe is an internal medicine resident in the Department of Medicine at Columbia University Medical Center in New York, New York. Dr Brown is the Gladys and Roland Harriman Professor of Medicine and clinical chief of the Division of Gastroenterology and Hepatology at Weill Cornell Medical College in New York, New York
| | - Robert S Brown
- Dr Jaffe is an internal medicine resident in the Department of Medicine at Columbia University Medical Center in New York, New York. Dr Brown is the Gladys and Roland Harriman Professor of Medicine and clinical chief of the Division of Gastroenterology and Hepatology at Weill Cornell Medical College in New York, New York
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11
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Kao JH, Asselah T, Dou XG, Hamed K. Telbivudine therapy for chronic hepatitis B: A journey to identify super-responders and to optimize treatment using the roadmap model. J Gastroenterol Hepatol 2017; 32:73-81. [PMID: 27515408 DOI: 10.1111/jgh.13512] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/03/2016] [Indexed: 02/06/2023]
Abstract
Hepatitis B virus (HBV) infection is one of the most serious health problems worldwide with a high risk for cirrhosis and liver cancer. Several antiviral agents have been approved for the treatment of chronic hepatitis B, leading to a rapid reduction in HBV DNA and normalization of serum alanine aminotransferase levels. Telbivudine, a potent inhibitor of HBV replication, has been shown to be well tolerated. Because of the emergence of drug resistance, optimization strategies for telbivudine therapy have been shown to improve patient responses. Optimal baseline characteristics in so-called super-responders have been used to predict the virological response. Baseline HBV DNA levels < 9 log10 copies/mL (2 × 108 IU/mL) or alanine aminotransferase levels of more than or equal to twofold the upper limit of normal in HBeAg-positive patients and HBV DNA < 7 log10 copies/mL (2 × 106 IU/mL) in HBeAg-negative patients were strong predictors for virological response. In addition, the roadmap model, based on early virological response at week 24 of therapy, is considered as a powerful tool to identify patients at risk of treatment failure (HBV DNA ≥ 300 copies/mL, i.e. 60 IU/mL) and to reduce the risk of antiviral resistance. When considering pre-treatment characteristics and on-treatment responses, telbivudine may provide physicians with a wide choice of options to effectively treat patients with chronic hepatitis B, especially those with or at risk of renal impairment, or women of childbearing age.
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Affiliation(s)
- Jia-Horng Kao
- Graduate Institute of Clinical Medicine and Hepatitis Research Center, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Tarik Asselah
- Hepatology Department, AP-HP, Beaujon Hospital, University Paris Diderot and INSERM UMR1149, Centre de Recherche sur l'inflammation, Labex INFLAMEX, Clichy, France
| | - Xiao-Guang Dou
- Department of Infectious Disease, Shengjing Hospital, China Medical University, Shenyang, China
| | - Kamal Hamed
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
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