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Liver Int. 2018 Mar 12. doi: 10.1111/liv.13736. [Epub ahead of print]
Mother to Child Transmission of Hepatitis B: Examining Viral Cut Offs, Maternal HBsAg Serology and Infant Testing.Thilakanathan C1,2,3, Wark G1, Maley M1,2,4, Davison S1, Lawler J5, Lee A1, Shackel N1,2,3, Nguyen V1, Jackson K6, Glass A1, Locarnini SA6, Levy MT1,2,3.
Author information
1Department of Gastroenterology and Liver, Liverpool Hospital, Sydney, Australia.2University of New South Wales, Sydney, Australia.3Ingham Institute, Sydney, Australia.4Department of Microbiology and Infectious Diseases, NSW Health Pathology, Liverpool.5Bankstown-Lidcombe Hospital, Sydney, Australia.6Victorian Infectious Diseases Reference Laboratory, WHO Regional Reference Laboratory for Hepatitis B, Doherty Institute, Melbourne, Australia.
AbstractBACKGROUND/AIMS: Anti-partum antiviral therapy in the setting of high viral load is recommended to prevent mother-to-child transmission of hepatitis B although recommended viral load cut-offs vary. Quantitative HBsAg has been proposed as an alternative screening strategy to identify high viral load in this setting. Guidelines suggest testing all infants for vaccine response and infection. We set out to re-examine viral load cut-offs; the predictive value of quantitative HBsAg and the need for follow-up infant testing in our cohort.
METHODS: A retrospective cohort study of 469 HBsAg positive mother-baby pairs from two tertiary hospitals in Sydney was performed. Antiviral therapy (lamivudine or tenofovir disoproxil fumarate) was offered to women with viral load ≥6 log10 IU/mL (high) from 32 weeks gestation. Transmission and vaccine response was analysed according to viral load. The utility of quantitative HBsAg in identifying high viral load was examined.
RESULTS: Mother-to-child transmission only occurred in setting of high viral load, in 0.85% (1/117) of those who received antiviral therapy and in 8.66% (2/23) of those who chose not to. Quantitative HBsAg did not accurately identify high risk mothers ≥6 log10 IU/mL. Infant vaccine response was 98.7% overall, and 99.4% when viral load was <6 log10 IU/mL.
CONCLUSION: Antiviral therapy initiated at 32 weeks when maternal viral load is ≥6 log10 IU/mL almost completely abrogates transmission. Quantitative HBsAg does not reliably predict high viral load. When maternal viral load is <6 log10 IU/mL, high vaccine efficacy and zero transmission suggests testing infants is of little value. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
KEYWORDS: HBV; Maternal viral load; Mother to child transmission; Quantitative HBsAg; perinatal transmission, Antiviral therapy; pregnancy; tenofovir
PMID:29532580DOI:10.1111/liv.13736
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