Hepatitis B in pregnancy
TL;DR: One in six women had active HBV requiring treatment or high HBV-DNA levels that would benefit from antiviral treatment to reduce the transmission risk.
Abstract: Objective Vertical transmission of the hepatitis B virus (HBV) is the commonest mode of infection and can be prevented with immunoprophylaxis of the infant and antiviral therapy in the mother. Our aim was to review a cohort of subjects with HBV in pregnancy to determine the prevalence of active disease or high HBV-DNA levels that required treatment to prevent transmission, and to review the management of mothers and infants. Methods A retrospective case-note review was conducted of all the HBV-infected pregnant women and their infants who attended the Newcastle obstetric services from 2007 to 2011. Results There were 113 pregnancies in 81 women (median age 28 years; 15% hepatitis B e antigen (HBeAg) positive) during 2007–11. 71% of mothers were first diagnosed with HBV during pregnancy. The mothers were born in 28 different countries. 69% of mothers had an HBV-DNA level less than 2000 IU/mL and 13% had HBV-DNA levels greater than 1.0×10 7 IU/mL so would be eligible for antiviral therapy to prevent transmission to the infant. 9% had active eAg-positive HBV and 3% had active eAg-negative HBV requiring treatment. All infants born to HBeAg-positive mothers received hepatitis B immunoglobulin (HBIG) appropriately and 76% of infants received a full HBV vaccination course. One infant born to an HBeAg-negative mother was hepatitis B surface antigen positive 1 year post-delivery. Conclusions One in six women had active HBV requiring treatment or high HBV-DNA levels that would benefit from antiviral treatment to reduce the transmission risk. HBIG was administered appropriately but completion of the vaccination course was suboptimal.
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TL;DR: It is demonstrated here that HBV exposure in utero triggers a state of trained immunity, characterized by innate immune cell maturation and Th1 development, which in turn enhances the ability of cord blood immune cells to respond to bacterial infection in vitro.
Abstract: The ability to fight infections matures after birth and is thus termed ‘trained immunity’. Here the authors show that cord blood cells from hepatitis B virus-infected mothers respond more strongly to bacterial infections, suggesting that viral exposure in utero promotes trained immunity in newborns.
139 citations
TL;DR: There have been great strides in the management of chronic hepatitis B virus (HBV) infection, but considerable challenges remain, and there is also a pressing need for novel HBV/hepatitis D virus co-infection therapies.
89 citations
Cites background from "Hepatitis B in pregnancy"
...Without prophylaxis, MTCT rate varies between 12% 768 and 90% depending on the mother’s HBV sero-status (Table 4) [108], although recent 769 studies have shown that viral load is the best predictor of newborn’s infection....
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TL;DR: The high prevalence of HBsAg among women of child bearing age suggests that vertical transmission of HBV may be a public health problem in Buea Health District and that health education on HBV should be provided to pregnant women especially during antenatal visits.
Abstract: Although infection with Hepatitis B Virus (HBV) remains a global public health problem, little is known about its epidemiology in pregnancy in sub-Saharan Africa. This study sought to determine the prevalence of, and identify factors associated with hepatitis B surface antigen (HBsAg) positivity among pregnant women in the Buea Health District (BHD) in rural Cameroon. We also assessed pregnant women’s knowledge about hepatitis B. A cross-sectional, descriptive study was undertaken. Participants were evaluated using a structured questionnaire with clinical examination and were then screened for HBsAg using a commercial rapid diagnostic test. Assessment of knowledge was done using a hepatitis B basic knowledge summary score. Of the 176 pregnant women studied, 9.7% (95% CI: 5.7%, 15%) tested positive for HBsAg. None of the risk factors assessed was significantly associated with HBsAg positivity. The hepatitis B knowledge summary score ranged from 0 to 12 with a mean of 1.5 (SD = 3.14, median = 0, IQR = 0 to 0). Only 16% of participants had scores greater than 6/12. The knowledge summary score of the participants was associated with the educational level (p-value = 0.0037). The high prevalence of HBsAg (9.7%) among women of child bearing age suggests that vertical transmission of HBV may be a public health problem in Buea Health District. Knowledge of HBV among pregnant women was poor. We recommend that all pregnant women ought to be routinely screened for HBV and that health education on HBV should be provided to pregnant women especially during antenatal visits.
87 citations
Cites background from "Hepatitis B in pregnancy"
...It is estimated that transmission rates can be as high as 12%, 25% and 70-90% respectively in HBeAg negative/anti-HBe positive mothers, HBeAg negative/anti-HBe negative mothers and HBeAg positive/anti-HBe negative mothers [26]....
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TL;DR: Universal screening of all pregnant women, at-birth prophylaxis with specific anti-HBV immune globulin, as well as HBV vaccination for newborns of infected mothers are effective in reducing the risk of vertical transmission, however, in cases of a high viral load and hepatitis B antigen positivity, there is a residual risk of HBV transmission to the newborn despite proprylaxis.
Abstract: More than 240 million people worldwide are chronically infected with hepatitis B virus (HBV). Mother-to-child transmission remains the most important mechanism of infection in countries with a high prevalence of HBV. Universal screening of all pregnant women, at-birth prophylaxis with specific anti-HBV immune globulin, as well as HBV vaccination for newborns of infected mothers are effective in reducing the risk of vertical transmission. However, in cases of a high viral load and hepatitis B e antigen positivity, there is a residual risk of HBV transmission to the newborn despite prophylaxis. This review focuses on the above-indicated strategies and on the efficacy and safety of antiviral drugs administered during the third trimester of pregnancy.
83 citations
Cites background or methods from "Hepatitis B in pregnancy"
...effect of HBV infection on pregnancy, the effect of pregnancy on HBV infection, the mother-to-child transmission of HBV, and the management of drugs.(2) The aim of this...
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...nucleotide analogs lamivudine, adefovir, telbivudine, enecavir, and tenofovir.(2) Of these, interferon and pegylated interferon are classified in pregnancy class X (ie, studies on animals or humans have revealed fetal abnormalities), and are therefore strongly contraindicated during pregnancy....
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...In fact, the rate of chronicity is about 90% in infants infected at birth or during the first year of life, 30%–50% in children aged 1–6 years, and 5%–10% in children above 6 years of age and in adults.(1,2)...
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...Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples, Italy Correspondence: Ivan Gentile Department of Clinical Medicine and Surgery (ed 18), University of Naples “Federico II”, via S Pansini 5, I-80131 Naples, Italy Tel +39 081 746 3178 Fax +39 081 746 3190 email ivan.gentile@unina.it tion in countries with a high prevalence of HBV. Universal screening of all pregnant women, at-birth prophylaxis with specific anti-HBV immune globulin, as well as HBV vaccination for newborns of infected mothers are effective in reducing the risk of vertical transmission....
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...It is currently administered to all HBsAg-positive mothers in most countries, and consists of both passive and active immunoprophylaxis.(2,22,23) In detail, newborns of HBsAg-positive mothers receive both hepatitis B immune globulin (HBIG) (passive immunoprophylaxis) and the first dose of the HBV vaccine (active prophylaxis)....
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TL;DR: Flares in HBV DNA and ALT can occur during late pregnancy and early postpartum in chronic hepatitis B women, and can be severe, and women with CHB should therefore be closely monitored duringregnancy and earlyPostpartum.
65 citations
References
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TL;DR: The 2009 update of the American Association for the Study of Liver Diseases (AASLD) Practice Guidelines for Management of Chronic Hepatitis B is now posted online at www.aasld.org, and the recommendation for first-line oral antiviral medications has been changed to tenofovir or entecavir, and adefovir has been moved to second-line Oral antiviral medication.
2,696 citations
TL;DR: A prospective general population study of 22 707 Chinese men in Taiwan has shown that the incidence of primary hepatocellular carcinoma (PHC) among carriers of hepatitis B surface antigen (HBsAg) is much higher than among non-carriers as discussed by the authors.
2,652 citations
Book•
01 Jan 2010
TL;DR: A group of experts in this field is assembled to present their expertise in such a level, where the practicing clinicians who deal with this disease in their daily practice can understand thereby implement this knowledge into their own practice.
Abstract: A recent Institute of Medicine report has concluded that 'there is a lack of knowledge and awareness about chronic viral hepatitis on the part of health-care and social-service providers, as well as among at-risk populations, members of the public, and policy-makers. Due to the insufficient understanding about the extent and seriousness of this public-health problem, inadequate public resources are being allocated to prevention, control, and surveillance programs'. It is with these concerns in mind that Dr. Tsai assembled a group of experts in this field to present their expertise in such a level, where the practicing clinicians who deal with this disease in their daily practice can understand thereby implement this knowledge into their own practice. Dr. Brian McMahon discusses the natural history of chronic hepatitis B with his vast knowledge and experience working with the high endemic population of Inuit in Alaska. Drs. Marc Ghany and Ed provide a very easy-to-understand description of HBV virology. Dr. Kyon-Mi Chang contributes an article on HBV immunology, which is the least understood area of this disease but has the most potential to improve our knowledge in the management of chronic hepatitis B. Dr. Anna Lok provides an authoritative review on the current issues and controversies of treatment of chronic hepatitis B. Dr. Stephen Locarnini, who has extensive experience in anti-viral resistance and its management, presents important issues in the usage of currently available anti-viral oral agents. Dr. Myron Tong discusses the current understanding of HBV carcinogenesis and updates HCC surveillance and treatment - the most dreadful outcome of this disease. Dr. Paul Martin discusses management of end- stage chronic hepatitis B - anti-viral therapy, montherapy vs combo therapy, choice of agent, when to start therapy and post-transplant patients including duration of HBIG therapy, HBcAb(+)only recipient) and Occult HBV infection. Dr. Tram Tran discusses the treatment in reproductive women, during pregnancy, and prevention of vertical transmission in third trimester with antiviral agents - an area with significant lack of good clinical evidence. Dr. Steve Han discusses management of patients with acute hepatitis B, co-infection with HDV/HCV/HIV, pre-immuno-suppressive therapy, and management of renal and heart transplant patients with HBV infection. Dr. Mei Huei Chang discusses Taiwanese success in implementing universal vaccination leading to a remarkable reduction in both prevalence of chronic hepatitis B and incidence of hepatocellular carcinoma. Finally Drs. Michelle Lai and Yun Fan Liaw provide a rundown of what we have accomplished and the hope for the future in our fight to control this disease.
1,464 citations
01 Jan 2013
TL;DR: The EASL CPGs on the management of HCV infection will be updated on a regular basis upon approval of additional novel therapies, and will apply to therapies that are approved at the time of their publication.
Abstract: Hepatitis C virus (HCV) infection is one of the main causes of chronic liver disease worldwide [1]. The long-term hepatic impact of HCV infection is highly variable, from minimal changes to chronic hepatitis, extensive fibrosis, and cirrhosis with or without hepatocellular carcinoma (HCC). The number of chronically infected persons worldwide may exceed 200 million, but most of them have no knowledge of their infection or of the ensuing hepatic condition. Clinical care for patients with HCV-related liver disease has advanced considerably during the last two decades, as a result of growing knowledge about the mechanisms of the disease, remarkable developments in diagnostic procedures, and advances in therapeutic and preventative approaches. Still, various aspects are not yet completely resolved. These EASL Clinical Practice Guidelines (CPGs) are intended to assist physicians and other healthcare providers, as well as patients and interested individuals, in the clinical decision-making process by describing optimal management of patients with acute and chronic HCV infections. These guidelines apply to therapies that are approved at the time of their publication. Several new therapeutic options have completed phase III development for patients infected with HCV genotype 1 and are currently awaiting licensing and approval in Europe and the United States. Therefore, the EASL CPGs on the management of HCV infection will be updated on a regular basis upon approval of additional novel therapies.
1,407 citations
TL;DR: The incidence of primary liver cancer is increasing in several developed countries including the United States, and the increase will likely continue for several decades.
1,088 citations