乙型肝炎的母婴传播：检查病毒截留值，母亲HBsAg血清学和婴

StephenW

Mother‐to‐child transmission of hepatitis B: Examining viral cut‐offs, maternal HBsAg serology and infant testing
Cynthuja Thilakanathan
Gabrielle Wark
Michael Maley
Scott Davison
Joseph Lawler
Aimei Lee
Nicholas Shackel
Vi Nguyen
Kathy Jackson
Anne Glass
Stephen A. Locarnini
Miriam T. Levy
First published: 12 March 2018
https://doi.org/10.1111/liv.13736

Funding informationA/Prof Levy has received payment for advisory board participation from Gilead.

Handling Editor: Chun‐Jen Liu

CT and GW joint first authors

Abstract
Background & Aims

Antipartum 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 2 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 HBV DNA ≥6 log10 IU/mL. Successful 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.

StephenW

乙型肝炎的母婴传播：检查病毒截留值，母亲HBsAg血清学和婴儿测试
Cynthuja Thilakanathan
加布里埃尔·沃克
迈克尔马利
斯科特戴维森
约瑟夫劳勒
艾美李
Nicholas Shackel
Vi Nguyen
凯西杰克逊
安妮玻璃
斯蒂芬A.洛加尼尼
Miriam T. Levy
首次发布：2018年3月12日
https://doi.org/10.1111/liv.13736

资金信息Levy教授已收到来自Gilead的咨询委员会参与费用。

处理编辑：刘春仁

CT和GW联合第一作者

抽象
背景和目的

建议在高病毒载量的情况下进行抗分步抗病毒治疗，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2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不能准确鉴定高危母亲HBVDNA≥6log10IU / mL。成功的婴儿疫苗应答总体为98.7％，当病毒载量<6 log10 IU / mL时为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。