The latest study that shows antivirals interrupt hepatitis B viral (HBV) transmission from mother-to-infant: H-L Chen et al. Hepatology 2015; 62: 375-86.
In this open-label, non-randomized controlled study from Taiwan, the researchers recruited women to receive tenofovir (TDF) at a dose of 300 mg once a day (n=62), initiated from gestational age 30-32 weeks until 1 month following delivery, and compared them to a control group (n=56). There were high levels of viremia with HBV DNA ≥7.5 log10 IU/mL. All infants received HBV vaccination and HBIG within 24 hours of birth.
- Infant transmission of HBV was reduced: at 6 months of age, infant HBsAg positivity was 1.54% versus 10.71%, P=0.0481). At delivery, HBV DNA positivity was noted in 6.15% compared with 31.48% of the control group.
- Maternal ALT was improved in the TDF group. ALT elevation more than two times the upper limit of normal for ≥3 months occurred in 3.23% compared with 14.29% of controls.
- Adverse effects: only mild to moderate (self-limited) gastrointestinal and skin symptoms were noted. No fetal abnormalities were identified.
Bottomline: Antivirals, including both tenofovir and telbivudine, reduce vertical HBV transmission with a favorable safety profile. The use of antivirals is complementary to standard prevention which consists of providing Hepatitis B immune globulin and Hepatitis B vaccine to infants of HBV-infected pregnant women within 12 hours of birth.
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