Abstract
ObjectiveTo evaluate the performance of hepatitis B-e antigen (HBeAg) for identifying pregnant women infected with hepatitis B virus (HBV) who are having a high viral load.MethodsA cross-sectional study was conducted at the tertiary care hospital in Bangkok, Thailand between August 2017 and August 2018. Ninety-six pregnant women having positive hepatitis B-s antigen (HBsAg) results were invited to participate into the study. Clinical data and blood samples were collected and tested for HBeAg and HBV DNA levels. Data were reported as percentage and 95% confidence interval (CI).ResultsHigh viral load was found in 25 women (26.0%, 95% CI: 18.3% to 35.6%) and HBeAg showed positive results in 33 women (34.4%, 95% CI: 25.6% to 44.3%). Among antiviral-naïve women, 24 of 30 cases having positive HBeAg results had high viral load (80.0%, 95% CI: 62.7% to 90.5%) while only 1 of 62 negative HBeAg women had high viral load (1.6%, 95% CI: 0.3% to 8.6%).ConclusionAbout one-fourth of HBV-infected pregnant women were at high risk for mother-to-child transmission (MTCT) of the virus and needed antiviral drugs for reducing MTCT. HBeAg may be used to identify women at high risk for MTCT of HBV in a low-resource setting where HBV DNA level test is not available.
Highlights
Hepatitis B virus (HBV) infection is a major global health problem
High viral load was found in 25 women (26.0%, 95% confidence interval (CI): 18.3% to 35.6%) and hepatitis B-e antigen (HBeAg) showed positive results in 33 women (34.4%, 95% CI: 25.6% to 44.3%)
Immunoprophylaxis failure was found in about 5-15% of infants and is more likely to occur in mothers testing positive for hepatitis B-e antigen (HBeAg) and/or high viral load or HBV DNA level [4,5]
Summary
Hepatitis B virus (HBV) infection is a major global health problem. In 2015, 257 million people worldwide were estimated to be chronically HBV-infected and almost 900,000 deaths resulted from long-term complications of chronic HBV infection including cirrhosis and hepatocellular carcinoma [1]. MTCT of HBV can be prevented by immunoprophylaxis strategies including administration of infant universal vaccination and passive immunization with hepatitis B immunoglobulin (HBIG) for infants from mothers having chronic HBV infection [3]. Immunoprophylaxis failure was found in about 5-15% of infants and is more likely to occur in mothers testing positive for hepatitis B-e antigen (HBeAg) and/or high viral load or HBV DNA level [4,5]. There is growing evidence of an antepartum antiviral drug in reducing MTCT of HBV in high viral load pregnant women [6,7,8,9,10]. In 2016, the American Association for the Study of Liver Diseases (AASLD) recommended providing antiviral therapy in HBV-infected pregnant women with an HBV DNA level >200,000 IU/ml [11]. It is suggested that these antivirals are started at 28-32 weeks of gestation and discontinued at birth to three months postpartum [11]
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