抗病毒治疗和停药预防怀孕期间HBV母婴传播的安全性。

StephenW

J Med Virol. 2020 May 15. doi: 10.1002/jmv.26011. [Epub ahead of print]
The safety of antiviral therapy and drug withdrawal for the prevention of mother-to-child transmission of HBV during pregnancy.
Xiao LX1, Chen YR2, Huang P3, Mei YY1, Pan CQ4,5, Lin CS1.
Author information
Abstract
BACKGROUND AND AIM:

The efficacy of prenatal antiviral therapy (AVT) for preventing the vertical transmission of hepatitis B virus (HBV) is well demonstrated. However, data are limited regarding the safety of postpartum cessation of AVT, which may induce alanine aminotransferase (ALT) elevation. We aimed to investigate the necessity of prolonging maternal AVT after delivery.
METHODS:

Chronic hepatitis B mothers at the immune-tolerant phase with HBV DNA levels > 6 log10 IU/ml were prospectively enrolled and received AVT during the third trimester until delivery. Patients were offered to discontinue AVT either at delivery or postpartum week (PPW) 6. In addition, mothers who deferred AVT during pregnancy served as the control group. All mothers were followed until postpartum week 52 for clinical and virological parameters of hepatitis flares.
RESULTS:

Among 118 mothers recruited, 91 received AVT with 53 (group A) and 24 (group B) discontinue their treatment at delivery and postpartum week 6, respectively. Twenty-seven mothers who deferred AVT during pregnancy were followed as the control (group C). Of 104/118 mothers who completed the study, 50% (52/104) had postpartum elevated ALT levels, which were mild and moderate except 6/104 (5.77%) of patients had levels > 5 times the upper limit of normal. 70% (36/52) of the ALT flares occurred within 12 weeks after delivery. In subgroup analyses, the freuquency of ALT elevation were similar among the groups A vs. B vs. C [50.9% (27/53) vs. 58.3% (14/24) vs 40.7% (11/27), respectively; P = 0.447], as well as the mean peak ALT level (108.4 / 74.1 / 126.7 U/L in groups A/B/C, respectively; P = 0.291).
CONCLUSIONS:

Although postpartum ALT flares were common for mothers with or without AVT during pregnancy, most cases of ALT elevation were mild to moderate. Our study observed that extending AVT to postpartum week 6 did not affect maternal outcomes and ATV should be discontinued at birth. Close monitoring is warrant as severe flares rarely occurred. ClinicalTrials.gov number: NCT03468907. This article is protected by copyright. All rights reserved.

This article is protected by copyright. All rights reserved.
KEYWORDS:

antiviral therapy; drug withdrawal; hepatitis B virus; mother-to-child transmission

PMID:
    32410298
DOI:
    10.1002/jmv.26011

StephenW

J Med Virol。 2020年5月15日。doi：10.1002 / jmv.26011。 [Epub提前发布]
抗病毒治疗和停药预防怀孕期间HBV母婴传播的安全性。
肖LX1，陈YR2，黄P3，梅YY1，潘CQ4,5，林CS1。
作者信息
抽象
背景与目的：

产前抗病毒治疗（AVT）预防乙型肝炎病毒（HBV）垂直传播的功效已得到充分证明。但是，关于产后停止AVT的安全性的数据有限，这可能会导致丙氨酸转氨酶（ALT）升高。我们旨在调查分娩后延长孕妇AVT的必要性。
方法：

HBV DNA水平> 6 log10 IU / ml的处于免疫耐受期的慢性乙型肝炎母亲被准入研究，并在妊娠中期至分娩前接受了AVT。在分娩或产后一周（PPW）6时，患者均需停​​止AVT。此外，在怀孕期间推迟AVT的母亲作为对照组。跟踪所有母亲直到产后第52周，了解肝炎发作的临床和病毒学参数。
结果：

在被招募的118位母亲中，有91位接受了AVT治疗，其中53位（A组）和24位（B组）分别在分娩时和产后第6周停药。追踪在妊娠期间推迟AVT的27位母亲作为对照组（C组）。在完成研究的104/118名母亲中，有50％（52/104）的产后ALT水平升高，为轻度和中度，只有6/104名（5.77％）的患者水平>正常上限的5倍。分娩后12周内发生了70％（36/52）的ALT发作。在亚组分析中，A，B，C组的ALT升高频率相似[分别为50.9％（27/53），58.3％（14/24）和40.7％（11/27）。 P = 0.447]，以及平均ALT峰值水平（A / B / C组分别为108.4 / 74.1 / 126.7 U / L； P = 0.291）。
结论：

尽管妊娠期间有或没有AVT的母亲普遍发生产后ALT发作，但大多数ALT升高病例为轻度至中度。我们的研究发现，将AVT延长至产后第6周不会影响母亲的结局，应在分娩时停用ATV。由于很少发生严重的耀斑，因此有必要进行密切监视。 ClinicalTrials.gov编号：NCT03468907。本文受版权保护。版权所有。

本文受版权保护。版权所有。
关键字：

抗病毒治疗；停药；乙型肝炎病毒;母婴传播

PMID：
    32410298
DOI：
    10.1002 / jmv.26011