Efficacy of nucleos(t)ide analogue antiviral therapy on interrupting mother-to-child transmission of hepatitis B virus

Abstract

Objective To investigate the initial gestational week of nucleos(t)ide analogue antiviral therapy on interrupting mother-to-child transmission (MTCT) of hepatitis B virus (HBV). Methods From January 1st, 2013 to April 1st, 2016, a total of 213 women with chronic HBV infection who received nucleos(t)ide antiviral treatment during maternal examinations at the Maternity Center of the 302 Military Hospital were hospitalized and completed one year follow-up after delivery. According to the initial antiviral time, these patients were divided into 24-week group (74 cases) and 28-week group (149 cases). The levels of serum HBV DNA decline, success rate of maternal and child block, complication in maternal and children as well as liver dysfunctions after antiviral therapy withdrawal between two groups were compared, respectively. Results The HBV DNA levels of pregnant women in the 24-week group and 28-week groups after 4 weeks of antiviral treatment were (4.53 ± 0.59) log10IU/ml and (4.42 ± 0.43) log10IU/ml, with significant difference (t = 1.58, P = 0.07), which was approximately 3.4 log10IU/ml lower than the baseline level. The HBV DNA levels of pregnant women in the 24-week group and 28-week groups after 8 weeks of antiviral therapy were (3.82 ± 0.43) log10IU/ml and (3.68 ± 0.39) log10IU/ml (t = 0.06, P = 2.44), with significant difference. The mean decrease level of HBV DNA in pregnant women during 4-8 weeks antiviral treatment was approximately 0.7 log10 IU/ml. The HBV DNA levels of prelaber in the two groups were (2.82 ± 0.48) log10IU/ml and (3.30 ± 0.53) log10IU/ml, with significant difference (t = 3.83, P = 0.07). HBV DNA groups were negative for HBsAg at 7 months and 12 months of age, and the success rate of maternal and infant blocks was 100%. There was no significant difference in maternal and child complications, neonatal growth and development indicators, birth defect rate and the incidence of ALT elevation after discontinuation. Conclusions Patients with high viral load of chronic HBV infection were not required to treat in advance in pregnancy, and could be delayed according to clinical needs, but should be guaranted for at least 4 weeks. Key words: Hepatitis B virus; Nucleotides; Pregnancy; Mother-to-child vertical transmission