母婴传播乙型肝炎：检查病毒截止，母亲HBsAg血清学和婴儿测

StephenW

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

StephenW

肝脏国际。 2018年3月12日：doi：10.1111 / liv.13736。 [电子版提前打印]
母婴传播乙型肝炎：检查病毒截止，母亲HBsAg血清学和婴儿测试。
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。
作者信息

1
    澳大利亚悉尼利物浦医院消化科和肝脏科。
2
    新南威尔士大学，澳大利亚悉尼。
3
    英格姆研究所，澳大利亚悉尼。
4
    新南威尔士州健康病理学，微生物学和传染病系，利物浦。
五
    Bankstown-Lidcombe医院，澳大利亚悉尼。
6
    维多利亚州传染病参考实验室，世界卫生组织乙型肝炎地区参考实验室，澳大利亚墨尔本多尔蒂研究所。

抽象
背景/目的：

建议在高病毒载量的情况下进行抗产后抗病毒治疗，以防止乙型肝炎的母婴传播，尽管推荐的病毒载量截止值有所不同。定量HBsAg已被提议作为一种替代筛选策略，以在此情况下确定高病毒载量。指南建议测试所有婴儿的疫苗反应和感染。我们着手重新检查病毒载量截止点;定量HBsAg的预测价值以及我们队列中对婴儿后续检测的需求。
方法：

对来自悉尼两家三级医院的469例HBsAg阳性母婴组进行回顾性队列研究。抗病毒治疗（拉米夫定或替诺福韦disoproxil延胡索酸）是从32周妊娠妇女病毒载量≥6log10 IU / mL（高）。根据病毒载量分析传播和疫苗应答。检测定量HBsAg在鉴别高病毒载量中的效用。
结果：

母婴传播仅发生在高病毒载量的情况下，0.85％（1/117）的接受抗病毒治疗的患者和8.66％（2/23）的患者选择不接受抗病毒治疗。定量HBsAg不能准确识别≥6log10 IU / mL的高危母亲。当病毒载量<6log10 IU / mL时，婴儿疫苗应答总体为98.7％，99.4％。
结论：

当孕妇病毒载量≥6log10IU / mL时，32周时开始抗病毒治疗，几乎完全消除了传播。定量HBsAg不能可靠预测高病毒载量。当母体病毒载量<6 log10 IU / mL时，高疫苗效力和零传播表明检测婴儿没有多大价值。本文受版权保护。版权所有。

本文受版权保护。版权所有。
关键词：

HBV;母体病毒载量;母婴传播;定量HBsAg;围产期传播，抗病毒治疗;怀孕;替诺福韦

结论：
    29532580
DOI：
    10.1111 / liv.13736

咬牙硬挺

感谢分享