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Use of Tenofovir Disoproxil Fumarate in Highly Viremic, Hepatitis B Mono-Infected Pregnant Women

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Abstract

Background

Antiviral therapy in addition to immunoprophylaxis at birth has been shown to further reduce perinatal transmission of hepatitis B virus (HBV) in highly viremic women.

Aims

The aim of this study was to describe the use of tenofovir disoproxil fumarate (TDF) prophylaxis to reduce maternal HBV DNA levels and potentially vertical transmission in highly viremic women.

Methods

After receiving IRB approval, we performed a retrospective chart review of mothers positive for hepatitis B surface antigen (HBsAg) who delivered between 2009 and 2012. We identified women with HBV DNA levels ≥6 log copies/mL who were treated with TDF in pregnancy.

Results

There were 22 women identified. The majority were of Micronesian ethnicity. All were negative for hepatitis C antibody and HIV infection. The median gestational age of TDF initiation was 31 weeks with a median duration of treatment of 45 days. There was a reduction in median HBV DNA levels from baseline 9.0 ± 2.0 to 5.4 ± 1.1 log copies/mL after treatment. There were five (22.7 %) preterm deliveries and five (22.7 %) cesarean deliveries. All infants received immunoprophylaxis at birth. Postnatal HBsAg testing at 9–12 months was available for 13 infants, 12 of which were negative. There was one case of perinatal transmission.

Conclusions

This is the second published case series to date on the use of TDF prophylaxis in HBV mono-infected, highly viremic mothers. This series suggests the use of TDF in pregnancy reduces maternal HBV DNA levels and is well tolerated.

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Acknowledgments

We would like to acknowledge Andrea Siu, Hawaii Pacific Health Research Institute, and Kalihi Palama Health Center for their assistance on this project.

Conflict of interest

Naoky Tsai has research grants provided by Gilead, BMS, Genentech/Roche, and Beckman, which did not fund this research. He is also on the speaker bureau for Gilead, BMS, and Genentech/Roche and is on the advisory board for BMS and Gilead. Seiji Yamada has previously served on the advisory board for Gilead. Pai-Jong Stacy Tsai, Marguerite Lisa Bartholomew, and Ann Chang report no conflict of interest.

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Authors and Affiliations

  1. Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology, and Women’s Health, John A. Burns School of Medicine, University of Hawaii, 1319 Punahou Street, Suite 824, Honolulu, HI, 96826, USA

    Pai-Jong Stacy Tsai & Marguerite Lisa Bartholomew

  2. Department of Family Medicine and Community Health, John A. Burns School of Medicine, University of Hawaii, 95-390 Kuahelani Avenue, Mililani, HI, 96734, USA

    Seiji Yamada

  3. Division of Gastroenterology, Department of Medicine, John A. Burns School of Medicine, University of Hawaii, 1356 Lusitana Street #711, Honolulu, HI, 96813, USA

    Naoky Tsai

  4. Department of Obstetrics, Gynecology, and Women’s Health, John A. Burns School of Medicine, University of Hawaii, 1319 Punahou Street, Suite 824, Honolulu, HI, 96826, USA

    Ann Chang

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  1. Pai-Jong Stacy Tsai
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Correspondence to Pai-Jong Stacy Tsai.

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Tsai, PJ.S., Chang, A., Yamada, S. et al. Use of Tenofovir Disoproxil Fumarate in Highly Viremic, Hepatitis B Mono-Infected Pregnant Women. Dig Dis Sci 59, 2797–2803 (2014). https://doi.org/10.1007/s10620-014-3230-3

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