母婴之间的HBV传播风险随着母体病毒载量而增加

StephenW

Mother-to-child HBV transmission risk increases with maternal viral load

Chen HL, et al. Hepatol Res. 2018;doi:10.1111/hepr.13072.
February 28, 2018

A systematic review and meta-analysis revealed that maternal viral load among mothers with hepatitis B was a significant risk factor for mother-to-child transmission, and was dose-dependent with HBV transmission incidence.

“Hepatitis B virus (HBV) infection is a major global health problem. According to WHO estimates, 240 million people are chronically infected with hepatitis B,” Hong-Lin Chen, MD, from the Nantong University, China, and colleagues wrote. “HBV infection acquired via mother-to-child transmission (MTCT) is typically considered to be one of the major causes of chronic infection.”


Chen and colleagues identified 21 studies with 10,142 mother-child pairs for evaluation. Most studies were published within the previous 10 years and were conducted in China. Mother-to-child transmission incidence ranged from 1.54% to 45.5%.

Mean mother-to-child transmission incidence in patients positive for HBV DNA was 13.1% (range, 3.1%-81.5%), compared with 4.2% (range, 0%-39.4%) among mothers negative for HBV DNA. Mothers positive for HBV DNA had a significantly higher risk for transmission to child (OR = 9.895; 95% CI, 5.333-19.359). The researchers found significant heterogeneity between studies (P < .00001), although there was evidence of publication bias.


The researchers conducted a subgroup analysis of mother-to-child transmission incidence by HBV DNA level. Among mothers with HBV DNA less than 6 log10 copies/mL, the researchers found that incidence ranged from 0% to 6.7% and pooled incidence was 2.754% (95% CI, 1.198-4.31). Mothers with HBV DNA higher than 8 log10 copies/mL had an incidence range from 7.6% to 33.3% and pooled incidence of 14.445% (95% CI, 8.317-20.572).

Finally, the researchers found that linear dose-response showed significant and evolutionary risk of mother-to-child transmission of HBV along increased maternal viral load (OR = 1.393; 95% CI, 1.218-1.594) for each log10 copy/mL increase. Compared with a reference of 3 log10 copies/mL, the odds ratio for transmission increased from 2.705 (95% CI, 1.808-4.047) among mothers with a viral load of 6 log10 copies/mL to 7.316 (95% CI, 3.268-16.378) among those with a viral load of 9 log10 copies/mL.

“Lowering the level of maternal HBV DNA during pregnancy is momentous for the prevention of MTCT in mothers with high viremia. However, there is still no consensus on the optimal cut-off value of maternal viral load for antiviral treatment,” the researchers wrote. “The result indicated the newborns still at risk when HBV DNA [less than] 6 log10 copies/mL. So, we think antiviral treatment maybe given when mothers with positive HBV DNA, rather than [higher than] 6 log10 copies/mL. However, this inference should be confirmed by other randomized controlled [trials].” – by Talitha Bennett

Disclosure: The authors report no relevant financial disclosures.

StephenW

母婴之间的HBV传播风险随着母体病毒载量而增加

Chen HL，et al。 Hepatol Res。 2018; DOI：10.1111 / hepr.13072。
2018年2月28日

一项系统回顾和荟萃分析显示，母亲与乙型肝炎母亲间的病毒载量是母婴传播的重要危险因素，并且与HBV传播发生率呈剂量依赖关系。

“乙型肝炎病毒（HBV）感染是一个主要的全球健康问题。据世界卫生组织估计，有2.4亿人长期感染乙型肝炎，“来自南通大学的Hong-Lin Chen博士及其同事写道。 “通过母婴传播（MTCT）获得的HBV感染通常被认为是慢性感染的主要原因之一。”
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Chen和他的同事们用10,142个母子对进行了21项研究的评估。大部分研究都是在过去10年内发表的，并在中国进行。母婴传播发生率介于1.54％至45.5％之间。

HBV DNA阳性患者的平均母婴传播发生率为13.1％（范围为3.1％-81.5％），而在HBV DNA阴性的母亲中为4.2％（范围为0％-39.4％）。 HBV DNA阳性的母亲传染给儿童的风险显着更高（OR = 9.895; 95％CI，5.333-19.359）。研究人员发现研究之间存在显着的异质性（P <0.00001），尽管有证据表明发表偏倚。
怀孕的女人

研究人员对HBV DNA水平进行了母婴传播发病率的亚组分析。在HBV DNA小于6log10拷贝/ mL的母亲中，研究人员发现发病率范围为0％至6.7％，合并发病率为2.754％（95％CI，1.198-4.31）。 HBV DNA高于8 log10拷贝/ mL的母亲的发生率为7.6％至33.3％，合并发病率为14.445％（95％CI，8.317-20.572）。

最后，研究人员发现，线性剂量反应显示随着母亲病毒载量增加（OR = 1.393; 95％CI，1.218-1.594），每次log10拷贝/ mL增加，HBV母婴传播的风险显着和进化。与3log10拷贝/ mL的参照相比，病毒载量为6log10拷贝/ mL的母亲中，传播的比值比从2.705（95％CI，1.808-4.047）增加至7.316（95％CI，3.268-16.378 ）病毒载量为9log10拷贝/ mL的患者中。

“在怀孕期间降低母体HBV DNA的水平对预防高病毒血症母亲的母婴传播非常重要。然而，对于抗病毒治疗的母体病毒载量的最佳截止值仍然没有达成共识，“研究人员写道。 “结果表明，当HBV DNA [小于] 6log10拷贝/ mL时，新生儿仍处于危险中。因此，我们认为，当HBV DNA阳性的母亲，而不是[高于] 6 log10拷贝/ mL时，可以给予抗病毒治疗。但是，这种推论应该由其他随机对照试验证实。“ - Talitha Bennett

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