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Lamivudine treatment and outcome in pregnant women with high hepatitis B viral loads

  • V. Jackson
  • W. Ferguson
  • T. B. Kelleher
  • M. Lawless
  • M. Eogan
  • U. Nusgen
  • S. Coughlan
  • J. Connell
  • J. S. Lambert
Article

Abstract

Perinatal transmission is the most common mode of hepatitis B virus (HBV) transmission and is a leading cause of chronic infection worldwide. Maternal treatment with lamivudine (LAM) can result in a rapid and significant reduction in HBV viral load (VL) and, thus, mitigate the risk of mother-to-child transmission (MTCT). The aim of this study was to retrospectively evaluate the safety of LAM treatment administered in the third trimester of pregnancy and determine the influence, if any, on infant outcome. The medical charts of all HBV surface antigen (HBsAg)-positive women eligible for treatment with LAM and who registered for antenatal care between 2007 and 2012 were retrospectively reviewed. During the 6-year period, 45 women met the criteria for LAM treatment. Thirty-six women (80 %) accepted treatment; the remaining women declined treatment (5), defaulted from care (3) or transferred to another maternity unit (1). The median duration of treatment was 11.4 weeks (range 5.3–17.4) and the median baseline VL was 1.4 × 108 IU/mL (range 1.8 × 107–1.7 × 108). The median VL at delivery was 2.3 × 105 IU/mL and 60 % of women achieved a VL reduction >2 log10 IU/mL before delivery. No cases of perinatal transmission occurred in the infants born to mothers who received treatment; however, one infant, born to a mother who defaulted from care, was HBV-infected at 8 months. The results suggest that LAM therapy in highly viraemic HBV-infected pregnant women could lower the rate of vertical transmission.

Keywords

Viral Load Perinatal Transmission Maternal Viral Load High Baseline Viral Load Immunoprophylaxis Failure 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Conflict of interest

The authors declare they have no conflict of interest.

Supplementary material

10096_2014_2270_MOESM1_ESM.doc (389 kb)
ESM 1 (DOC 389 kb)

References

  1. 1.
    Custer B, Sullivan SD, Hazlet TK, Iloeje U, Veenstra DL, Kowdley KV (2004) Global epidemiology of hepatitis B virus. J Clin Gastroenterol 38(10 Suppl 3):S158–S168CrossRefPubMedGoogle Scholar
  2. 2.
    Franco E, Bagnato B, Marino MG, Meleleo C, Serino L, Zaratti L (2012) Hepatitis B: Epidemiology and prevention in developing countries. World J Hepatol 4(3):74–80CrossRefPubMedCentralPubMedGoogle Scholar
  3. 3.
    World Health Organization (WHO) (2013) Hepatitis B. Fact sheet no 204, July 2013. Available online at: http://www.who.int/mediacentre/factsheets/fs204/en/. Accessed 25 October 2013
  4. 4.
    van Nunen AB, de Man RA, Heijtink RA, Niesters HG, Schalm SW (2000) Lamivudine in the last 4 weeks of pregnancy to prevent perinatal transmission in highly viremic chronic hepatitis B patients. J Hepatol 32:1040–1041CrossRefPubMedGoogle Scholar
  5. 5.
    Xu WM, Cui YT, Wang L et al (2009) Lamivudine in late pregnancy to prevent perinatal transmission of hepatitis B virus infection: a multicentre, randomized, double-blind, placebo-controlled study. J Viral Hepat 16:94–103CrossRefPubMedGoogle Scholar
  6. 6.
    Pan CQ, Duan ZP, Bhamidimarri KR et al (2012) An algorithm for risk assessment and intervention of mother to child transmission of hepatitis B virus. Clin Gastroenterol Hepatol 10(5):452–459CrossRefPubMedGoogle Scholar
  7. 7.
    Cheung KW, Seto MTY, Wong SF (2013) Towards complete eradication of hepatitis B infection from perinatal transmission: review of the mechanisms of in utero infection and the use of antiviral treatment during pregnancy. Eur J Obstet Gynecol Reprod Biol 169(1):17–23CrossRefPubMedGoogle Scholar
  8. 8.
    Wen WH, Chen HL, Ni YH et al (2011) Secular trend of the viral genotype distribution in children with chronic hepatitis B virus infection after universal infant immunization. Hepatology 53:429–436CrossRefPubMedGoogle Scholar
  9. 9.
    Torii N, Hasegawa K, Ogawa M, Hashimo E, Hayashi N (2002) Effectiveness and long-term outcome of lamivudine therapy for acute hepatitis B. Hepatol Res 24(1):34CrossRefPubMedGoogle Scholar
  10. 10.
    Schmilovitz-Weiss H, Ben-Ari Z, Sikuler E et al (2004) Lamivudine treatment for acute severe hepatitis B: a pilot study. Liver Int 24(6):547–551CrossRefPubMedGoogle Scholar
  11. 11.
    Lisotti A, Azzaroli F, Buonfiglioli F, Montagnani M, Alessandrelli F, Mazzella G (2008) Lamivudine treatment for severe acute HBV hepatitis. Int J Med Sci 5(6):309–312CrossRefPubMedCentralPubMedGoogle Scholar
  12. 12.
    Brown RS Jr, Verna EC, Pereira MR et al (2012) Hepatitis B virus and human immunodeficiency virus drugs in pregnancy: findings from the Antiretroviral Pregnancy Registry. J Hepatol 57(5):953–959CrossRefPubMedGoogle Scholar
  13. 13.
    Nayeri UA, Werner EF, Han CS, Pettker CM, Funai EF, Thung SF (2012) Antenatal lamivudine to reduce perinatal hepatitis B transmission: a cost-effectiveness analysis. Am J Obstet Gynecol 207(3):231.e1–231.e7CrossRefGoogle Scholar
  14. 14.
    Wiseman E, Fraser MA, Holden S et al (2009) Perinatal transmission of hepatitis B virus: an Australian experience. Med J Aust 190(9):489–492PubMedGoogle Scholar
  15. 15.
    Zou H, Chen Y, Duan Z, Zhang H, Pan C (2012) Virologic factors associated with failure to passive–active immunoprophylaxis in infants born to HBsAg-positive mothers. J Viral Hepat 19(2):e18–e25CrossRefPubMedGoogle Scholar
  16. 16.
    Han L, Zhang HW, Xie JX, Zhang Q, Wang HY, Cao GW (2011) A meta-analysis of lamivudine for interruption of mother-to-child transmission of hepatitis B virus. World J Gastroenterol 17(38):4321–4333CrossRefPubMedCentralPubMedGoogle Scholar
  17. 17.
    Kao JH, Liu CJ, Chen DS (2002) Hepatitis B viral genotypes and lamivudine resistance. J Hepatol 36:303–304CrossRefPubMedGoogle Scholar
  18. 18.
    Chien RN, Yeh CT, Tsai SL, Chu CM, Liaw YF (2003) Determinants for sustained HBeAg response to lamivudine therapy. Hepatology 38:1267–1273CrossRefPubMedGoogle Scholar
  19. 19.
    Chan HL, Wong ML, Hui AY et al (2003) Hepatitis B virus genotype has no impact on hepatitis B e antigen seroconversion after lamivudine treatment. World J Gastroenterol 9:2695–2697PubMedGoogle Scholar
  20. 20.
    Yuen MF, Wong DK, Sablon E et al (2003) Hepatitis B virus genotypes B and C do not affect the antiviral response to lamivudine. Antivir Ther 8:531–534PubMedGoogle Scholar
  21. 21.
    Lau DT, Khokhar MF, Doo E et al (2000) Long-term therapy of chronic hepatitis B with lamivudine. Hepatology 32(4 Pt 1):828–834CrossRefPubMedGoogle Scholar
  22. 22.
    Liaw YF (2001) Impact of YMDD mutations during lamivudine therapy in patients with chronic hepatitis B. Antivir Chem Chemother 12(Suppl 1):67–71PubMedGoogle Scholar
  23. 23.
    Lok AS, Lai CL, Leung N et al (2003) Long-term safety of lamivudine treatment in patients with chronic hepatitis B. Gastroenterology 125:1714–1722CrossRefPubMedGoogle Scholar
  24. 24.
    Lai CL, Gane E, Liaw YF et al (2007) Telbivudine versus lamivudine in patients with chronic hepatitis B. N Engl J Med 357:2576–2588CrossRefPubMedGoogle Scholar
  25. 25.
    ter Borg MJ, Leemans WF, de Man RA, Janssen HLA (2008) Exacerbation of chronic hepatitis B infection after delivery. J Viral Hepat 15(1):37–41PubMedGoogle Scholar
  26. 26.
    Dusheiko G (2012) Interruption of mother-to-infant transmission of hepatitis B: time to include selective antiviral prophylaxis? Lancet 379:2019–2021CrossRefPubMedGoogle Scholar
  27. 27.
    National Institute for Health and Care Excellence (NICE) (2013) Hepatitis B (chronic): Diagnosis and management of chronic hepatitis B in children, young people and adults. NICE guidelines [CG165], issued June 2013. Available online at: http://www.nice.org.uk/guidance/cg165. Accessed 25 October 2013

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • V. Jackson
    • 1
  • W. Ferguson
    • 1
  • T. B. Kelleher
    • 1
    • 2
  • M. Lawless
    • 1
  • M. Eogan
    • 1
  • U. Nusgen
    • 3
  • S. Coughlan
    • 4
  • J. Connell
    • 4
  • J. S. Lambert
    • 1
    • 2
    • 5
    • 6
  1. 1.Department of Infectious DiseasesThe Rotunda HospitalDublinIreland
  2. 2.Department of Infectious DiseasesThe Mater Misericordiae University HospitalDublinIreland
  3. 3.Department of MicrobiologyThe Rotunda HospitalDublinIreland
  4. 4.The National Virus Reference LaboratoryUniversity College DublinDublinIreland
  5. 5.School of Medicine & Medical ScienceUniversity College DublinDublinIreland
  6. 6.Catherine McAuley Research CentreMater Misericordiae University HospitalDublin 7Ireland

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