Perinatal Transmission Of Hepatitis Research Articles

Factors associated with hepatitis B infection in pregnant women at health facilities in the health district of Mokolo/Far North of Cameroon

Introductionla transmission périnatale de l´hépatite B est responsable de plus d´un tiers des hépatites virales dans les régions à forte endémicité. Cette étude vise à analyser les facteurs associés à l´infection de l´hépatite B chez les femmes enceintes dans le district de santé de Mokolo/Extrême-Nord Cameroun.Méthodesune étude transversale a été mobilisée d´avril 2020 à janvier 2021. Un échantillon de 794 femmes enceintes consentantes a été constitué par quota et par convenance dans sept formations sanitaires du district de santé de Mokolo. Les données sociodémographiques et les antécédents ont été collectés. La recherche des marqueurs sériques de l´hépatite B, et les co-infections (Virus de l´Immunodéficience Humaine, syphilis et hépatite C) a été réalisée. Le degré d´association avec le portage de l´AgHbs a été recherché pour un seuil de signification fixé à 5%.Résultatsaprès l´analyse de régression logistique multivariée, le niveau d´étude (OR = 1,58 IC à 95% = 1,08-2,30 p = 0,019), la profession du partenaire (OR = 4,07 IC à 95% = 1,33-12,53 p = 0,014), le premier trimestre de la grossesse (OR = 2,38 IC à 95% = 1,12-5,04 p = 0,024) et la sérologie syphilis (OR = 3,27 IC à 95% = 1,29-8,28 p = 0,012) se sont révélés être des facteurs de risque majeurs. La séroprévalence de l´AgHbs est de 18,4% (IC à 95% = 15,9-21,3) avec une positivité à l´AgHbe de 13,7% (IC à 95% = 7,5-19,9) dans le district de santé de Mokolo.Conclusionplusieurs facteurs ont été identifiés et reconnus comme prédicteurs de l´hépatite B conformément à la littérature. Certains facteurs tels que: la profession « Indéterminée » du partenaire et la sérologie de la syphilis sont les résultats spécifiques à cette étude, mais restent à confirmer.

Распространенность ко-инфекции ВИЧ/ВГС у беременных. Факторы риска перинатальной передачи ВИЧ/ВГС

The review provides up-to-date statistical data on the prevalence, transmission routes, and risks of perinatal transmission of hepatitis C virus, immunodeficiency virus, and variants of their co-infections from mother to child. The increase in the number of HIV/HCV co-infected women of reproductive age makes it urgent to develop a strategy for the prevention of vertical transmission of HIV/HCV co-infection based on the treatment of viral hepatitis C during pregnancy planning and three-stage prevention of perinatal transmission of HIV infection at the onset of pregnancy. Key words: HIV infection, chronic viral hepatitis C, HIV/HCV co-infection, perinatal HIV transmission, perinatal transmission of viral hepatitis C infection, risks of perinatal HIV transmission, risks of perinatal hepatitis C virus transmission, risk factors for perinatal HIV/HCV co-infection transmission

Tenofovir Alafenamide to Prevent Perinatal HBV Infection

Research Article| May 01 2021 Tenofovir Alafenamide to Prevent Perinatal HBV Infection AAP Grand Rounds (2021) 45 (5): 59. https://doi.org/10.1542/gr.45-5-59 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Tenofovir Alafenamide to Prevent Perinatal HBV Infection. AAP Grand Rounds May 2021; 45 (5): 59. https://doi.org/10.1542/gr.45-5-59 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: hepatitis b, perinatal period, tenofovir alafenamide Source: Zeng Q-L, Yu Z-J, Ji F, et al. Tenofovir alafenamide to prevent perinatal hepatitis B transmission: a multicenter, prospective, observational study [published online ahead of print January 4, 2021]. Clin Infect Dis. 2021;ciaa1939. doi: https://doi.org/10.1093/cid/ciaa1939Google Scholar Investigators from multiple institutions in China conducted a prospective study to assess the safety and effectiveness of tenofovir alafenamide fumarate (TAF), an alternative to tenofovir disoproxil fumarate (TDF), in preventing mother-to-child perinatal transmission of hepatitis B virus (HBV). Study participants were pregnant women with HBV DNA levels >200,000 IU/mL who were assigned on a 1:1 basis to receive TAF or TDF during pregnancy. In addition to demographic information, HBeAg status and HBV DNA levels were collected at baseline. Data on adverse events were collected, and maternal levels of alanine aminotransferase (ALT) and hepatitis B status were obtained when the women gave birth and... You do not currently have access to this content.

Evidence for Use of Tenofovir in Pregnancy to Prevent Perinatal Transmission of Hepatitis B Infection.

Perinatal transmission of hepatitis B virus continues to be a serious global public health concern. Transmission failures are related to high maternal viremia. Several antiviral therapies reduce maternal viremia around the time of delivery and decrease maternal-to-child-transmission. This chapter is a review of current studies that, ultimately, have provided strong evidence for the efficacy and safety of 3 antiviral drugs in pregnancy-lamivudine, telbivudine and tenofovir. The latter drug is the particular focus of this chapter which will show that tenofovir is the preferred antiviral therapy in pregnant women because of its potency, safety profile, and low risk of resistance.

Comparing the Efficacy and Safety of Treating Chronic Hepatitis B Infection during Pregnancy with Lamivudine, Telbivudine, and Tenofovir: A Meta-analysis

Background and Aims: The perinatal transmission of hepatitis B virus (HBV) remains an important global health problem. Here, a systematic review and meta-analysis were conducted to evaluate the evidence regarding the efficacy and maternal/fetal safety of treating pregnant women with lamivudine, telbivudine (LdT), and tenofovir (TDF).Methods: A PubMed and Scopus search resulted in 1,076 records, which were reduced to 36, containing 7,717 pregnant women with chronic HBV infection and 7467 infants meeting the inclusion criteria. The latest search was in August 2019.Results: Treatment with LdT, but not lamivudine and TDF, could significantly reduce the hepatitis B virus surface antigen-positive rate (odds ratio (OR) = 0.37) in infants; it also led to higher rates of hepatitis B e antigen loss (OR = 12.14), hepatitis B e antigen seroconversion (OR = 8.93), and alanine aminotransferase normalization in mothers (OR = 1.49). Each of these treatments was able to significantly reduce HBV DNA positivity at birth (total OR = 0.19) and mother-to-child-transmission of HBV (total OR = 0.15), and to cause higher rates of HBV DNA suppression in mothers (total OR = 25.53). However, nucleos(t)ide analogues might also be involved in creatine kinase elevation (total OR = 7.48). In contrast, no significant association was found between nucleos(t)ide analogue therapy and preterm/premature births, congenital malformation, low birth weight, and abortion or fetal/infant death. The results suggested LdT’s high capability of preventing mother-to-child-transmission. However, TDF failed to show significant associations to a reduced risk of mother-to-child-transmission, probably due to the low number of patients included.Conclusions: Although using either lamivudine, LdT, or TDF could lead to more favorable maternal/fetal outcomes, LdT seemed to show more potential in resolving certain infant- and maternal-related outcomes. More studies on the safety profile of such treatments are required.

Perinatal Transmission of Hepatitis C Among High-Risk Women

Perinatal Transmission of Hepatitis C Among High-Risk Women

Abstracts from the NIH Office of Research on Women's Health 2018 Annual BIRCWH Meeting – Building Interdisciplinary Research Careers in Women's Health November 28, 2018

Abstracts from the NIH Office of Research on Women's Health 2018 Annual BIRCWH Meeting – Building Interdisciplinary Research Careers in Women's Health November 28, 2018

Heterogeneity of Hepatitis B Infection Among Pregnant Asian American and Pacific Islander Women

Perinatal transmission of hepatitis B virus among Asian Americans and Pacific Islanders is a key driver of racial health disparities in liver cancer and mortality in the U.S. This study documents the prevalence of hepatitis B virus infection among pregnant women across racial/ethnic groups and among Asian Americans and Pacific Islanders to assess the need for intervention, and then identifies the individual correlates of hepatitis B virus infection among Asian American and Pacific Islander pregnant women. Using the 2014-2015U.S. birth rate population data, this study estimates a series of logistic regression models to examine the associations between individual-level correlates and hepatitis B virus infection among Asian American and Pacific Islanders pregnant women. Data were analyzed in July 2017. Among Asian American and Pacific Islander pregnant women, Chinese American mothers are ten times more likely to experience hepatitis B virus infection than are Asian Indian and Japanese American mothers. Foreign-born mothers are significantly more likely to experience hepatitis B virus infection during pregnancy than those of their U.S.-born counterparts. Maternal SES characteristics are important correlates of hepatitis B virus infection among pregnant women. Studies must disaggregate the pan-ethnic Asian American and Pacific Islander category to examine the health and health disparities of Asian Americans and Pacific Islanders. Given the heterogeneity of hepatitis B virus infection prevalence among Asian American and Pacific Islander pregnant women, the effectiveness of prevention and intervention programs depends on careful consideration of ethnicity in conjunction with group-specific factors.

Linking Susceptibility to Infectious Diseases to Immune System Abnormalities among HIV-Exposed Uninfected Infants.

HIV-exposed uninfected (HEU) infants experience increased overall mortality from infectious causes when compared to HIV-unexposed uninfected (HU) infants. This is the case in both the resource-rich and resource-limited settings. Here, we explore the concept that specific types of infectious diseases that are more common among HEU infants could provide clues as to the potential underlying immunological abnormalities. The most commonly reported infections in HEU vs. HU infants are caused by encapsulated bacteria, suggesting the existence of a less effective humoral (antibody, complement) immune response. Decreased transplacental transfer of protective maternal antibodies has consistently been observed among HEU newborns, suggesting that this may indeed be one of the key drivers of their susceptibility to infections with encapsulated bacteria. Reassuringly, HEU humoral response to vaccination appears to be well conserved. While there appears to be an increase in overall incidence of acute viral infections, no specific pattern of acute viral infections has emerged; and although there is evidence of increased chronic viral infection from perinatal transmission of hepatitis C and cytomegalovirus, no data exist to suggest an increase in adverse outcomes. Thus, no firm conclusions about antiviral effector mechanisms can be drawn. However, the most unusual of reported infections among the HEU have been opportunistic infections, suggesting the possibility of underlying defects in CD4 helper T cells and overall immune regulatory function. This may relate to the observation that the immunological profile of HEUs indicates a more activated T cell profile as well as a more inflammatory innate immune response. However, both of these observations appear transient, marked in early infancy, but no longer evident later in life. The causes of these early-life changes in immune profiles are likely multifactorial and may be related to in utero exposure to HIV, but also to increased environmental exposure to pathogens from sicker household contacts, in utero and postnatal antiretroviral drug exposure, and, in certain circumstances, differences in mode of feeding. The relative importance of each of these factors will be important to delineate in an attempt to identify those HEU at highest risk of adverse outcomes for targeted interventions.

Cost-effectiveness of antiviral therapy during late pregnancy to prevent perinatal transmission of hepatitis B virus.

Background. Hepatitis B virus (HBV) infections are perinatally transmitted from chronically infected mothers. Supplemental antiviral therapy during late pregnancy with lamivudine (LAM), telbivudine (LdT), or tenofovir (TDF) can substantially reduce perinatal HBV transmission compared to postnatal immunoprophylaxis (IP) alone. However, the cost-effectiveness of these measures is not clear.Aim. This study evaluated the cost-effectiveness from a societal perspective of supplemental antiviral agents for preventing perinatal HBV transmission in mothers with high viral load (>6 log10 copies/mL).Methods. A systematic review and network meta-analysis were performed for the risk of perinatal HBV transmission with antiviral therapies. A decision analysis was conducted to evaluate the clinical and economic outcomes in China of four competing strategies: postnatal IP alone (strategy IP), or in combination with perinatal LAM (strategy LAM + IP), LdT (strategy LdT + IP), or TDF (strategy TDF + IP). Antiviral treatments were administered from week 28 of gestation to 4 weeks after birth. Outcomes included treatment-related costs, number of infections, and quality-adjusted life years (QALYs). One- and two-way sensitivity analyses were performed to identify influential clinical and cost-related variables. Probabilistic sensitivity analyses were used to estimate the probabilities of being cost-effective for each strategy.Results. LdT + IP and TDF + IP averted the most infections and HBV-related deaths, and gained the most QALYs. IP and TDF + IP were dominated as they resulted in less or equal QALYs with higher associated costs. LdT + IP had an incremental $2,891 per QALY gained (95% CI [$932–$20,372]) compared to LAM + IP (GDP per capita for China in 2013 was $6,800). One-way sensitivity analyses showed that the cost-effectiveness of LdT + IP was only sensitive to the relative risk of HBV transmission comparing LdT + IP with LAM + IP. Probabilistic sensitivity analyses demonstrated that LdT + IP was cost-effective in most cases across willingness-to-pay range of $6,800 ∼ $20,400 per QALY gained.Conclusions. For pregnant HBV-infected women with high levels of viremia, supplemental use of LdT during late pregnancy combined with postnatal IP for infants is cost-effective in China.

Risk factors for vertical transmission of hepatitis C virus: a single center experience with 710 HCV-infected mothers

ObjectiveThe aim of this study was to analyze the risk factors on the perinatal transmission of hepatitis C virus (HCV). Study designA retrospective cohort study with 711 infants born to 710 HCV-infected mothers was conducted at the Hospital La Fe, in Valencia, Spain, from 1986 to 2011. As potential risk factors for transmission we analyzed: maternal age, mode of acquisition of HCV infection, HIV co-infection, antiretroviral treatment against HIV, CD4 cell count, HIV and HCV viral load, liver enzyme levels during pregnancy, smoking habit, gestational age, intrapartum invasive procedures, length of rupture of membranes, length of labor, mode of delivery, episiotomy, birth weight, newborn gender and type of feeding. ResultsOverall perinatal HCV transmission rate was 2.4%. The significant risk factors related with HCV transmission were maternal virus load >615copies/mL (OR 9.3 [95% CI 1.11–78.72]), intrapartum invasive procedures (OR 10.1 [95% CI 2.6–39.02]) and episiotomy (OR 4.2 [95% CI 1.2–14.16]). HIV co-infection and newborn female were near significance (p=0.081 and 0.075, respectively). ConclusionsInvasive procedures as fetal scalp blood sampling or internal electrode and episiotomy increase vertical transmission of HCV, especially in patients with positive HCV RNA virus load at delivery.

Perinatal transmission of hepatitis C antigens: envelope 1, envelope 2 and non-structural 4

Background: Perinatal exposure to hepatitis C virus (HCV) antigens during pregnancy may affect the developing immune system in the fetus. We aimed to study the perinatal transmission of HCV structural and non-structural antigens. Methods: Sera from 402 pregnant mothers were tested for anti-HCV antibody and HCV RNA. HCV antigens were determined in sera from 101 HCV-infected mothers and their cord blood. Results: In both serum and cord blood samples, HCV NS4 (non-structural 4) at 27 kDa, E1 (envelope 1) at 38 kDa and E2 (envelope 2) at 40 kDa were identified, purified and quantified using western blotting, electroelution and ELISA. Maternal sera and neonate cord blood samples had similar detection rates for NS4 (94.1%), E1 (90.1%) and E2 (90.1%). The mean maternal serum levels (optical density, OD) of HCV NS4 (0.87 ± 0.01), E1 (0.86 ± 0.01) and E2 (0.85 ± 0.01) did not differ significantly (p > 0.05) from those of neonatal cord blood (0.83 ± 0.01, 0.87 ± 0.01 and 0.85 ± 0.01, respectively). Also, strong correlations (p < 0.0001) were shown between sera and cord blood sample levels of HCV NS4, r = 0.77; E1, r = 0.76 and E2, r = 0.80. The vertical transmission of these antigens in vaginal delivery did not differ significantly (p > 0.05) from those in caesarean section. Conclusions: These findings indicate that vertical transmission of HCV NS4, E1 and E2 antigens was very high. Thus, exposure to these antigens may influence the developing immune responses to natural infection or future vaccination.

Immunization of babies born to HBsAg positive mothers: An audit on the delivery and completeness of follow up in Norfolk and Suffolk, United Kingdom

Perinatal transmission of hepatitis B infection has increased in the UK over the last decade. Routine antenatal screening of pregnant mothers (based on HBsAg) provides an effective means to identify ‘at risk’ babies. Follow up of babies born to infected mothers involves 4 doses of vaccination and/or a single dose of HBIG at birth. In this study we report the outcome of follow up of babies born to infected mothers over a 5 y period. One hundred sixty-three babies born to HBsAg positive mothers were followed up to ascertain the completeness for immunization and serological testing. Vaccination completion was 99.4% (162 of babies) at birth (1st dose), 95.6% (152 babies) for the second dose (at 1st month), 94.3 % (148 babies) for the 3rd dose (at 2nd month) and 83.4% (106 babies) for the 4th dose (at 12 months). Additionally, at 12 months 29.9% (38) of babies had their blood tested serologically to ascertain infection status; all babies receiving antigen testing were HBsAg negative. The overall vaccination coverage was good, although there is scope to improve the coverage of 4th dose. However, the proportion of children who were serologically tested for surface antigen at 12 months was considerably lower and there is a greater need to test babies concurrently at the time of giving the 4th dose. The proposed dried blood spot testing which will be rolled out from September 2014 should address this issue.

The effects of Telbivudine for the prevention of perinatal transmission of hepatitis B virus infection from pregnant women to newborn on the expression of IL-17A,IL-10,IL-6 in the maternal plasma,umbilical plasma,neonatal plasma

Objective To explore the expression of interleukin-17A(IL-17A),interleukin-10(IL-10),interleukin-6(IL-6)in the maternal plasma,umbilical plasma,neonatal plasma from the pregnant women who accepted the Telbivudine for the prevention of perinatal transmission of hepatitis B virus infection. Methods 85 pregnant women who were delivered in the hospital were chosen[Telbivudine group 25 cases,HBVDNA high viral level group,HBVDNA negative group,non-infection group(health pregnant),each group included 20 cases].The level of the serum of IL-17A,IL-10,IL-6 in the maternal plasma,umbilical plasma,neonatal plasma from the different group was prospectively analyzed by the CBA method. Results The levels of IL-17A in the maternal plasma,umbilical plasma,neonatal plasma of the Telbivudine group[(15.29±4.80)pg/ m L,(19.45±4.80)pg/m L,(17.32±4.18)pg/m L]were lower than the HBVDNA high viral level group[(26.03±4.88)pg/m L,(34.07±5.59)pg/m L,(24.12±4.76)pg/m L],there were significant differences(P= 0.000, 0.001,0.019);The level of IL-10 in the maternal plasma,umbilical plasma,neonatal plasma of the Telbivudine group[(6.08±1.32)pg/m L,(2.33±0.68)pg/m L,(3.74±0.61)pg/m L]were higher than the HBVDNA high viral level group[(3.95±1.21)pg/m L,(1.71±0.53)pg/m L,(2.22±0.55)pg/m L],there were significant differences(P= 0.023,0.015,0.012);The level of IL-6 in the maternal plasma,umbilical plasma,neonatal plasma of the Telbivudine group were lower than the HBVDNA high viral level group,there were significant differences(all P<0.05). Conclusion Telbivudine can cause the inhibition of the replication of HBV virus,partially reverse the immunologic dissonance of the pregnant women with HBV virus,which is conducive to maintaining pregnancy. Key words: Hepatitis Brirus; Interleukins; Telbivudine

Efficacy and Safety of Tenofovir and Lamivudine in Late Pregnancy for Preventing Perinatal Transmission of Hepatitis B Virus in Highly Viremic Mothers

Background: Chronic hepatitis B virus (HBV) infection early in the life confers a high risk of chronicity, particularly in children born to highly viremic mothers, due to “viral vaccine breakthrough” phenomenon that could be treated by antivirals such as lamivudine and recently tenofovir. Objective: We evaluated efficacy and safety of lamivudine and tenofovir in late pregnancy in preventing perinatal transmission of hepatitis B virus (HBV) to infants born to highly viremic mothers. Materials and Methods: A total of 82 pregnant chronic HBsAg+ women with high viremia (>107 copies/mL) at 32 weeks of gestation were randomly assigned to 2 groups (lamivudine 100 mg or tenofovir 300 mg daily from 8 weeks of prepartum to week 4 postpartum). Infants received recombinant HBV vaccine without HBIg and were followed until week 52. Results: HBV perinatal trasmission rate, defined by HBsAg presence in children’s blood at week 52, was only 1.2% (1/82). The mean maternal viral load sharply decreased from 5.09 x 108 ± 3.19 x 108 copies/mL at week 32 of gestation to 1.13 x 106 ± 3.91 x 106 at labor (p<0.001). The viral load reduction was stronger in tenofovir-treated mothers than in lamivudine-treated ones (p<0.028), particularly in 4 log10 reduction (p<0.001). No viral resistance to the drugs was noted. Drug adverse events were rare and transient, allowing complete full course in all cases, and flare was seen in no case. Conclusion: Both lamivudine and tenofovir exhibited a high efficacy in preventing mother-to-child perinatal transmission of HBV and a good safety without viral resistance.

The role of non-invasive ventilation for patients with pandemic H1N1 2009 influenza admitted at ICU in Albania

Background: Perinatal transmission of Hepatitis B virus (HBV) serves as the major vehicle through which a population of chronically infected people who serve as infectious HBV reservoirs is maintained in communities. Hence, the importance of identifying HBV infected pregnant women in a bid to reduce perinatal HBV transmission Methods M median age: 31 years) attending antenatal clinics in Ibadan metropolis, Southwestern Nigeria were screened for HBsAg, HBeAg, HBeAb and HBc IgM using ELISA technique. All samples previously positive for HBsAg, HbeAg or HBc IgMwere subjected toHBVDNAdetectionby amplificationof the Sgene. Subsequently, the ampliconwas sequenced and isolateswere genotyped and subtyped based on amino acid residues at positions 122, 127, 134 and 160 of the S-gene. Results: Seventeen (6.25%) of the pregnant women screened had evidence of recentHBV infection (HbsAg positive =15;HBc IgM positive =2). The 2 womenwith detectable HBc IgM had no HBsAg. Seven out of the 17 women had detectable HBV DNA. Further analysis shows that 5 of the isolates were genotype E subtype ayw4. The remaining 2 isolates could not be typedbecause onehad F134V substitution and the other R122Q substitutionwhich led to the loss of immunodominant HBsAg subtype determinants. Furthermore, the latter isolate also had C124Y, A128T, G130K, M133T, C138Y, G145K, C147Y, C149Y, A157T AND A159K substitutions which are characteristic of vaccine escape mutants. Conclusion: This study confirms high endemicity of HBV, the risk of perinatal transmission and the ciculation of genotype E subtype ayw4 in Nigeria. It further demonstrates the need to include HBc IgM in HBV screening protocols for pregnant women. In addition, the findings of this study show the presence and possible circulation of vaccine escape mutants in the population.

456: Cost effectiveness of antiviral therapies in the prevention of perinatal transmission of hepatitis B virus (HBV) in highly viremic women

456: Cost effectiveness of antiviral therapies in the prevention of perinatal transmission of hepatitis B virus (HBV) in highly viremic women

Perinatal Transmission of Hepatitis C Virus

The perinatal transmission of hepatitis C virus (HCV) is the major route of infection in infants. The understanding of the risk factors of perinatal infection and the continuation of studies in this area allow one to propose immunological algorithms of prediction and to work outa follow-up strategy of infected children. The authors have made virological and Immunological studies of infants born to mothers with HCV infection.

New drugs for the treatment of chronic hepatitis B and interdisciplinary aspects of chronic hepatitis B virus infection

Hepatitis B virus infection is a significant health problem worldwide. The prevalence of HBsAg positivity is about 0.5-0.7% in Hungary. Liver cirrhosis and/or hepatocellular carcinoma develops in 15-40% of chronic hepatitis B virus infected patients without treatment. The ultimate goal of treatment would be to clear the virus from the infected subject; however, in practice, we can usually achieve long term suppression of viral replicaton with consequent prevention of the progression of liver disease, and reduction of the risk of the development of liver cirrhosis and hepatocellular carcinoma. Currently, there are two different treatment strategies for patients with chronic hepatitis B virus infection: therapy of finite duration with interferon or long-term treatment with nucleot(s)ide analogues. Entecavir and tenofovir are the two most effective nucleot(s)ide analogues with high barrier to resistance, thus, they can be confidently used as first-line treatments. Lamivudine engenders very high rates of resistance; adefovir is less efficacious than entecavir or tenofovir, and also engendering higher rates of resistance, thus none of them are recommended for initiation of a new treatment. Tenofovir is the treatment option in cases with lamivudine resistance, because entecavir has an unfavourable resistance-profile in this group of patients. Interferon is contraindicated during pregnancy. Should treatment of chronic hepatitis B virus infection be necessary during pregnancy, tenofovir, listed by the FDA as pregnancy category B drug, is to be preferred. Nucleot(s)ide analogues may be used to reduce the risk of intra-uterine and perinatal transmission of hepatitis B virus, which may occur in a proportion of newborns from highly viremic mothers, despite active and passive immunization. Similarly, tenofovir is recommended in the last trimester of pregnancy for women with high viremia. The risk of reactivation of chronic hepatitis B virus infection is high in HBsAg positive patients, and in patients with occult hepatitis B virus infection during and after chemotherapy or immunosuppressive treatment, including biological response modifiers (particularly related to rituximab therapy). Therefore, all candidates for these treatments should be screened for HBsAg and anti-HBc. Pre-emptive nucleot(s)ide analogues therapy should be initiated in patients with HBsAg positivity, and patients with occult hepatitis B virus infection. The role of general practitioners and occupational health physicians in the identification and the prevention of hepatitis B virus infection is stressed. Issues of high risk population groups, candidacy for vaccination, and methodology of active and passive immunisation are also reviewed in this paper.

Cesarean Section Reduces Perinatal Transmission of Hepatitis B Virus Infection From Hepatitis B Surface Antigen–Positive Women to Their Infants

Despite appropriate passive and active immunization, perinatal transmission of hepatitis Bvirus (HBV) still occurs in 5%-10% of infants born to women with high levels of viremia who test positive for the hepatitis B e antigen (HBeAg). We evaluated the effects of cesarean section delivery on perinatal transmission of HBV from women who tested positive for the hepatitis B surface antigen (HBsAg). We analyzed data from 1409 infants born to HBsAg-positive mothers through vaginal delivery (VD) (n= 673), elective caesarean section (ECS) (n= 496), or urgent cesarean section (UCS) (n= 240) who completed appropriate immunization against HBV. The prevention was assumed to have failed for infants who were HBsAg positive when they were 7-12 months old; this information was used to assess transmission rates. HBV infection was transmitted to a smaller percentage of infants born by ECS (1.4%) than by VD (3.4%, P < .032) or UCS (4.2%, P < .020). UCS had no effect on vertical transmission, compared with VD (4.2% vs 3.4%, P= .593). Infants born by ECS had a significantly lower rate of vertical transmission than those born by non-ECS (1.4% vs 3.6%, P= .017). Women with HBV DNA levels <1,000,000 copies/mL did not transmit the infection to their infants, regardless of method of delivery. There were no differences in maternal or infant morbidity and mortality among the groups. There is a significantly lower rate of vertical transmission of HBV infection to infants delivered by ECS, compared with those delivered vaginally or by UCS. Elective cesarean sections for HBeAg-positive mothers with pre-delivery levels of HBV DNA ≥1,000,000 copies/mL could reduce vertical transmission.