2199. Antiviral Therapy Use in Hepatitis B-Infected Pregnant Women

Background Perinatal Hepatitis B Virus (HBV) transmission results in chronic disease in 90% of infected infants. Immunoprophylaxis reduces perinatal HBV infections by 95%. For women with viral loads >200,000 IU/mL, antiviral therapy during pregnancy is recommended to further reduce perinatal transmission. We sought to characterize antiviral therapy use in Hepatitis B-infected pregnant women. Methods The Centers for Disease Control and Prevention (CDC) provided auxiliary funding for five Perinatal Hepatitis B Prevention Programs. We analyzed data collected retrospectively from Hepatitis B-infected pregnant women in Georgia, Michigan, New York City, Philadelphia, and Wisconsin identified as having live births during April 2016–December 2017. We assessed maternal antiviral therapy use during pregnancy; HBV DNA levels included in our analysis were from the last result available prior to delivery for each woman. Results We identified 3,971 pregnant women with HBV infection; of these, 803 (20.2%) had information regarding prescription of antiviral therapy during pregnancy. HBV DNA levels were known for 1,907 women, of whom 9.1% (n = 173) had HBV DNA >200,000 IU/mL nearest delivery. Antiviral therapy was prescribed for 26.5% (n = 213) of women with information. Antiviral therapy was more commonly prescribed for women aged <30 years vs. ≥30 years (32.0% vs. 23.1%, P = 0.0069), Asian/Pacific Island race vs. White or Black (42.7% vs. 2.8% and 6.2%, respectively, P < 0.0001), and those whose HBV was monitored by a gastroenterologist/hepatologist vs. maternal fetal medicine or infectious disease specialist (55.1% vs. 10.3% and 36.4%, respectively, P < 0.0001). Tenofovir was prescribed for 92.9% of women prescribed antiviral therapy; lamivudine was prescribed for 3.8%. Conclusion Antiviral therapy was prescribed for one-fourth of Hepatitis B-infected women with information and was more commonly prescribed for women who were younger, Asian/Pacific Island race, and who received Hepatitis B care from a gastroenterologist/hepatologist. Although these are preliminary findings and data collection is ongoing, opportunities may exist to improve guideline-concordant antiviral therapy use among Hepatitis B-infected pregnant women. NOTE: Prevention of perinatal HBV transmission is an off-label use of antiviral therapy. Disclosures P. Fineis, CDC: Grant Investigator, Grant recipient.