Outcome after discontinuing antiviral agents during pregnancy in women infected with hepatitis B virus
Hee Yeon Kim , Jong Young Choi email address , Chung-Hwa Park , Jeong Won Jang , Chang Wook Kim , Si Hyun Bae , Seung Kew Yoon , Jin Mo Yang , Chang Don Lee , Young Sok Lee
Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
Received 24 September 2012; received in revised form 18 November 2012; accepted 26 November 2012. published online 02 January 2013.
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Abstract
Background
Women who are taking antiviral agents and become pregnant have several options that include, continuing therapy, ceasing drugs, or switching to safer drugs. However, there are limited data on the outcome in pregnant women after withdrawal of antiviral agents.
Objectives
We aimed to investigate the outcome of stopping antiviral agents in pregnant women with chronic hepatitis B virus (HBV) infection.
Study design
In this single-center, retrospective cohort study, 12 pregnant patients who had received antiviral therapy for HBV and cease drugs after awareness of pregnancy between 2003 and 2010 were enrolled. We retrospectively studied virologic and biochemical flares during pregnancy and postpartum period.
Results
Median age at pregnancy was 30.5 (range, 24–35) years, median duration of antiviral drug before pregnancy was 15.3 (range, 3.0–131.3) months, and median HBV DNA at withdrawal of therapy was 4.8 (range, 1.7–8.0) log10 copies/mL. Eight out of twelve patients (66.7%) had a viral rebound after stopping antiviral drugs during pregnancy. Severe hepatitis flares, defined as a 5-fold increase in serum alanine aminotransferase (ALT), were observed in six patients (50%) during pregnancy. However, all of these patients spontaneously recovered without an event of hepatic decompensation. High pretreatment ALT was associated with severe hepatitis flares after cessation of therapy during pregnancy. Five patients with at least 1-year treatment before pregnancy maintained low hepatitis activity after delivery.
Conclusions
Pregnant women with high pretreatment ALT or those treated less than 1 year before pregnancy have high risk of severe hepatitis flares after cessation of antiviral agents.