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Clinical course of 161 untreated and tenofovir‐treated chronic hepatitis B pregnant patients in a low hepatitis B virus endemic region
Author(s) -
Samadi Kochaksaraei G.,
Castillo E.,
Osman M.,
Simmonds K.,
Scott A. N.,
Oshiomogho J. I.,
Lee S. S.,
Myers R. P.,
Martin S. R.,
Coffin C. S.
Publication year - 2016
Publication title -
journal of viral hepatitis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.329
H-Index - 100
eISSN - 1365-2893
pISSN - 1352-0504
DOI - 10.1111/jvh.12436
Subject(s) - medicine , gastroenterology , hbeag , hepatitis b , hepatitis b virus , tenofovir , pregnancy , viral load , hbsag , immunology , virus , biology , human immunodeficiency virus (hiv) , genetics
Summary Hepatitis B immunoprophylaxis failure is linked to high maternal viraemia. There is limited North American data on hepatitis B outcomes in pregnancy. Pregnant hepatitis B carriers were enrolled January 2011–December 2014 and offered tenofovir in the 3rd trimester if hepatitis B virus ( HBV )‐ DNA was >7‐log IU/mL. Outcomes were determined in treated vs untreated patients. In total, 161 women with 169 pregnancies (one twin, 170 infants; median age 32 years), 18% (29/161) HB eAg+ and median HBV ‐ DNA 2.51 log IU /mL ( IQR 1.66–3.65; range 0.8–8.1) were studied. 14.3% (23/161) received tenofovir due to high viral load (16/23, median 74 days, IQR 59–110) or due to liver disease (7/23). In 10/16 treated due to high viraemia, with confirmed adherence, follow‐up HBV ‐ DNA showed a 5.49 log decline ( P = 0.003). In treatment naïve mothers, median alanine aminotransferase ( ALT ) increased from 17 IU /L ( IQR 12–24) to 29 ( IQR 18–36) post‐partum ( P = 1.5e‐7). In seven highly viraemic mothers who declined therapy ( HBV ‐ DNA >8‐log IU /mL); median ALT increased ~3X from baseline ( P < 0.01). 26% (44/169) had Caesarean section with no difference in treated vs untreated subjects. No tenofovir‐treated mothers had renal dysfunction. Data were available on 167/170 infants; in 50.8% (85/167) who completed immunoprophylaxis, 98.8% (84/85, including 12 exposed to tenofovir in utero ) were HBV immune. One infant born to an HB eAg+ mother with HBV ‐ DNA >8‐log IU /mL failed immunoprophylaxis. In this prospective Canadian cohort study, most untreated mothers experienced mild HBV flares. Tenofovir in pregnancy is well tolerated and reduces viral load prior to parturition.