CHRONIC HEPATITIS B VIRUS INFECTION IN PREGNANCY: STRATEGIES OF ANTIVIRAL THERAPY

Cover Page


Cite item

Full Text

Abstract

Treatment of chronic hepatitis B during pregnancy is an extremely complicated issue. Despite  implementation of immune prophylaxis, a significant proportion of babies born by mothers with  high viral load are infected by hepatitis B virus.  Cumulative data suggest that antiviral therapy in  the 3  trimester of pregnancy is an effective intervention in the event of unsuccessful immune prord phylaxis. To minimize fetal effects of nucleoside  and nucleotide analogues, antiviral therapy during  pregnancy should be administered to mothers with high risk of disease progression and/or uncontrolled hepatitis B virus infection. The safety  data obtained indicate that telbivudine and tenofovir can be used during pregnancy. Nevertheless,  antiviral therapy requires a  thorough assessment of the risk to benefit ratio.

About the authors

P. O. Bogomolov

Moscow Regional Research and Clinical Institute

Author for correspondence.
Email: macievich@gmail.com
Bogomolov Pavel Olegovich – PhD, Head of the Moscow Regional Hepatology Center; Deputy Chief Physician in Clinical and Diagnostic Operations Russian Federation

M. V. Matsievich

Moscow Regional Research and Clinical Institute

Email: macievich@gmail.com
Matsievich Mariya Vladislavovna – PhD, Research Fellow, Department of Gastroenterology and Hepatology Russian Federation

K. Yu. Kokina

Moscow Regional Research and Clinical Institute

Email: macievich@gmail.com
Kokina Kseniya Yur'evna – Gastroenterologist, Hepatology Department, Consultative and Diagnostics Department Russian Federation

N. V. Voronkova

Moscow Regional Research and Clinical Institute

Email: macievich@gmail.com
Voronkova Natal'ya Vasil'evna – PhD, Specialist in Infectious Diseases, Hepatology Department, Consultative and Diagnostics Department Russian Federation

O. S. Kuz'mina

Moscow Regional Research and Clinical Institute

Email: macievich@gmail.com
Kuz'mina Ol'ga Sergeevna – PhD, Head of the Hepatology Department, Consultative and Diagnostics Department Russian Federation

A. O. Bueverov

Moscow Regional Research and Clinical Institute; I.M. Sechenov First Moscow State Medical

Email: macievich@gmail.com
Bueverov Aleksey Olegovich – MD, PhD, Professor, Chair of Medical and Social Expert Assessment and Out-Patient Therapy of the Postgraduate Medical Training Faculty, Leading Research Fellow, Department of Research on Innovative Therapy, Research Center Russian Federation

References

  1. World Health Organisation. Hepatitis B. [Accessed 28 November 2014]. Available from: http://www.who.int/csr/disease/hepatitis/ whocdscsrlyo20022/en/index1.htm
  2. Ozaras R, Inanc Balkan I, Yemisen M, Tabak F. Epidemiology of HBV subgenotypes D. Clin Res Hepatol Gastroenterol. 2015;39(1):28–37. doi: 10.1016/j.clinre.2014.06.005.
  3. Bissinger AL, Fehrle C, Werner CR, Lauer UM, Malek NP, Berg CP. Epidemiology and genotyping of patients with chronic hepatitis B: genotype shifting observed in patients from Central Europe. Pol J Microbiol. 2015;64(1):15–21.
  4. Söderström A, Norkrans G, Lindh M. Hepatitis B virus DNA during pregnancy and postpartum: aspects on vertical transmission. Scand J Infect Dis. 2003;35(11–12):814–9.
  5. Tan HH, Lui HF, Chow WC. Chronic hepatitis B virus (HBV) infection in pregnancy. Hepatol Int. 2008;2(3):370–5. doi: 10.1007/s12072-0089063-4.
  6. Lin HH, Wu WY, Kao JH, Chen DS. Hepatitis B post-partum e antigen clearance in hepatitis B carrier mothers: correlation with viral characteristics. J Gastroenterol Hepatol. 2006;21(3):605–9.
  7. ter Borg MJ, Leemans WF, de Man RA, Janssen HL. Exacerbation of chronic hepatitis B infection after delivery. J Viral Hepat. 2008;15(1):37–41.
  8. Yang YB, Li XM, Shi ZJ, Ma L. Pregnant woman with fulminant hepatic failure caused by hepatitis B virus infection: a case report. World J Gastroenterol. 2004;10(15):2305–6.
  9. Xu WM, Cui YT, Wang L, Yang H, Liang ZQ, Li XM, Zhang SL, Qiao FY, Campbell F, Chang CN, Gardner S, Atkins M. Lamivudine in late pregnancy to prevent perinatal transmission of hepatitis B virus infection: a multicentre, randomized, double-blind, placebo-controlled study. J Viral Hepat. 2009;16(2):94–103. doi: 10.1111/j.1365-2893.2008.01056.x.
  10. Wiseman E, Fraser MA, Holden S, Glass A, Kidson BL, Heron LG, Maley MW, Ayres A, Locarnini SA, Levy MT. Perinatal transmission of hepatitis B virus: an Australian experience. Med J Aust. 2009;190(9): 489–92.
  11. Xu DZ, Yan YP, Choi BC, Xu JQ, Men K, Zhang JX, Liu ZH, Wang FS. Risk factors and mechanism of transplacental transmission of hepati tis B virus: a case-control study. J Med Virol. 2002;67(1):20–6.
  12. Schillie S, Walker T, Veselsky S, Crowley S, Dusek C, Lazaroff J, Morris SA, Onye K, Ko S, Fenlon N, Nelson NP, Murphy TV. Outcomes of infants born to women infected with hepatitis B. Pediatrics. 2015;135(5):e1141–7. doi: 10.1542/peds.2014-3213.
  13. Pan CQ, Duan ZP, Bhamidimarri KR, Zou HB, Liang XF, Li J, Tong MJ. An algorithm for risk assessment and intervention of mother to child transmission of hepatitis B virus. Clin Gastroenterol Hepatol. 2012;10(5):452–9. doi: 10.1016/j. cgh.2011.10.041.
  14. European Association For The Study Of The Liver. EASL clinical practice guidelines: Management of chronic hepatitis B virus infection. J Hepatol. 2012;57(1):167–85. doi: 10.1016/j. jhep.2012.02.010.
  15. Lok AS, McMahon BJ. Chronic hepatitis B: update 2009. Hepatology. 2009;50(3):661–2. doi: 10.1002/hep.23190.
  16. Antiviral Pregnancy Registry (APR). Antiviral Pregnancy Registry Interim Report 1, 1 January 1989 through 1 January 2015. Available from: http://www.apregistry.com/forms/interim_report.pdf
  17. Han GR, Cao MK, Zhao W, Jiang HX, Wang CM, Bai SF, Yue X, Wang GJ, Tang X, Fang ZX. A prospective and open-label study for the efficacy and safety of telbivudine in pregnancy for the prevention of perinatal transmission of hepatitis B virus infection. J Hepatol. 2011;55(6):1215– 21. doi: 10.1016/j.jhep.2011.02.032.
  18. Pan CQ, Han GR, Jiang HX, Zhao W, Cao MK, Wang CM, Yue X, Wang GJ. Telbivudine prevents vertical transmission from HBeAg-positive women with chronic hepatitis B. Clin Gastroenterol Hepatol. 2012;10(5):520–6. doi: 10.1016/j.cgh.2012.01.019.
  19. Zhang H, Pan CQ, Pang Q, Tian R, Yan M, Liu X. Telbivudine or lamivudine use in late pregnancy safely reduces perinatal transmission of hepatitis B virus in real-life practice. Hepatology. 2014;60(2):468–76.
  20. Alimenti A, Burdge DR, Ogilvie GS, Money DM, Forbes JC. Lactic acidemia in human immunodeficiency virus-uninfected infants exposed to perinatal antiretroviral therapy. Pediatr Infect Dis J. 2003;22(9):782–9.
  21. Shah I. Lactic acidosis in HIV-exposed infants with perinatal exposure to antiretroviral therapy. Ann Trop Paediatr. 2009;29(4):257–61. doi: 10.1179/027249309X12547917868880.
  22. Gibb DM, Kizito H, Russell EC, Chidziva E, Zalwango E, Nalumenya R, Spyer M, Tumukunde D, Nathoo K, Munderi P, Kyomugisha H, Hakim J, Grosskurth H, Gilks CF, Walker AS, Musoke P; DART trial team. Pregnancy and infant outcomes among HIV-infected women taking long-term ART with and without tenofovir in the DART trial. PLoS Med. 2012;9(5):e1001217. doi: 10.1371/journal. pmed.1001217.
  23. Han GR, Jiang HX, Zhao W, Ge CY, Xu CL, Pan C. Lamivudine use in the 2 nd or 3 trimester of pregnancy has similar efficacy in preventing vertical transmission of chronic hepatitis B in highly viremic mothers. Hepatology. 2011;54(S1):479A.rd
  24. Pan CQ, Mi LJ, Bunchorntavakul C, Karsdon J, Huang WM, Singhvi G, Ghany MG, Reddy KR. Tenofovir disoproxilfumarate for prevention of vertical transmission of hepatitis B virus infection by highly viremic pregnant women: a case series. Dig Dis Sci. 2012;57(9):2423–9. doi: 10.1007/s10620-012-2187-3.
  25. Shaheen AA, Myers RP. The outcomes of pregnancy in patients with cirrhosis: a population-based study. Liver Int. 2010;30(2):275–83. doi: 10.1111/j.1478-3231.2009.02153.x.
  26. Beasley RP, Stevens CE, Shiao IS, Meng HC. Evidence against breast-feeding as a mechanism for vertical transmission of hepatitis B. Lancet. 1975;2(7938):740–1.
  27. Hill JB, Sheffield JS, Kim MJ, Alexander JM, Sercely B, Wendel GD. Risk of hepatitis B transmission in breast-fed infants of chronic hepatitis B carriers. Obstet Gynecol. 2002;99(6):1049–52.
  28. Van Rompay KK, Hamilton M, Kearney B, Bischofberger N. Pharmacokinetics of tenofovir in breast milk of lactating rhesus macaques. Antimicrob Agents Chemother. 2005;49(5): 2093–4.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2015 Bogomolov P.O., Matsievich M.V., Kokina K.Y., Voronkova N.V., Kuz'mina O.S., Bueverov A.O.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies