Abstract
: Mother to child transmission (MTCT) is the most important mode of acquisition of hepatitis B. MTCT is dependent on HBeAg status and HBV DNA levels. There is lack of information about HBeAg status and HBV DNA levels in HBsAg pregnant women in India.We aimed to determine the frequency of Hepatitis B infection, HBeAg positive status, its association with HBV viral load and compared the differences in clinical and laboratory characteristics between HBeAg positive and negative cohort.: We extracted demographic, laboratory and virological characteristics from case records of pregnant women with HBV seen by department of Obstetrics and Gynaecology and Gastroenterology between January 2011 and December 2018. Patients were stratified into HBeAg positive and negative groups. Descriptive statistics were carried out. : The prevalence of HBsAg positive pregnancy was 0.63% (130/20624 deliveries). Of the 89 patients in whom e antigen results were available, 14 (15.7%) were HBeAg positive and 73 (82%) were HBeAg negative. HBeAg positive women were younger (24y vs 27y), had higher AST (36 vs 18), ALT (56 vs 23) and HBV DNA level (1.3x10 vs 54 IU/ml) levels compared to HBeAg negative women. 12/14 HBeAg positive women received antivirals to prevent MTCT.: Hepatitis B prevalence in our cohort is 0.63%. HBeAg positive status was seen in 15.7% of pregnant women and was associated with high viral load of >10/copies/ml. 82% were HBeAg negative and associated with low viral load. HBeAg can be used as a surrogate marker for viral load and has immunoprophylaxis and treatment implications.
Highlights
The global burden of Hepatitis B virus is 257 million with India falling in the intermediate endemic category with a prevalence of 2-7%. 1,2 there is variation within the country.[3]
It is estimated that 17 million of the 257 million Hepatitis B chronic carriers worldwide are in India. 1,4 the national carrier rate of Hepatitis B in India is reported as 4%, there is considerable variability within different areas of the country with a lower prevalence in Southern part of India compared to the rest of the country. 3,11 The seroprevalence of hepatitis B virus (HBV) in pregnancy in our study was 0.63% which is similar to 2 other studies from India carried out from Allahabad and Mumbai. 9,10 The0.63% prevalence is much lower than the national average of 4% and highlights the heterogeneity of HBV status in our country
Only 15% of these HBV infected women were hepatitis B e antigen (HBeAg) positive in our study. This low proportion of HBeAg positive women is striking and contrasts with the 56.8% reported by Dwivedi et al which attests to the considerable heterogeneity of the hepatitis B surface antigen (HBsAg) positive population. 9 (Table 3)
Summary
The global burden of Hepatitis B virus is 257 million with India falling in the intermediate endemic category with a prevalence of 2-7%. 1,2 there is variation within the country.[3]. Two critical factors are central to mother to child transmission (MTCT) These include maternal hepatitis B e antigen (HBeAg) status and HBV DNA levels. Whereas HBeAg is widely available, HBV DNA viral load limited by its availability, has a turnaround time of days to a couple of weeks and is expensive We aimed to determine the frequency of Hepatitis B infection, HBeAg positive status, its association with HBV viral load and compared the differences in clinical and laboratory characteristics between HBeAg positive and negative cohort. HBeAg positive status was seen in 15.7% of pregnant women and was associated with high viral load of >106/copies/ml. HBeAg can be used as a surrogate marker for viral load and has immunoprophylaxis and treatment implications
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