Vertical Transmission Of HBV Research Articles

Hepatitis co-infection in paediatric HIV: progressing treatment and prevention.

To analyse the main evidence and recommendations for the management of hepatitis co-infection in children living with HIV. We analysed available data pertaining to the natural history of liver disease and treatment of co-infected children. Viral hepatitis co-infection in people living with HIV (PLHIV) is a global problem owing to the shared routes of transmission, particularly in areas of high endemicity for the three viruses. Viral hepatitis co-infection can accelerate liver disease progression and increase morbidity and mortality, even in patients on suppressive antiretroviral treatment (ART). Viral hepatitis should be routinely screened in PLHIV and, once diagnosed with viral hepatitis, PLHIV should be closely monitored for liver disease progression and complications. Children living with HIV-HBV co-infection should be treated with ART containing agents which are active against both viruses. Children living with HIV-HCV co-infection should receive directly acting antivirals (DAA) to eradicate HCV infection. Prevention measures to reduce vertical and horizontal transmission of HBV and HCV (anti-HBV vaccination and immunoglobulins, anti-HBV treatment in pregnancy, anti-HCV DAAs in people of childbearing age, avoiding blood contact, sexual barrier precautions) should be adopted and encouraged, particularly in high endemicity countries.

Hepatitis B infection status among South Africans attending public health facilities over a five-year period: 2015 to 2019.

Hepatitis B, a potentially life-threatening viral infection of the liver, remains a global public health concern despite the availability of effective vaccines for over three decades. The aim of our study was to provide national data on active hepatitis B infections in the public health sector of South Africa. We conducted retrospective analyses on national laboratory data over the period 2015 to 2019. We identified 176,530 cases who tested positive for HBsAg (active infection) with a test positivity rate of 9.02%. Of these active infections, 11,355 (6.43%) were found to be chronically infected. We linked 24,839 (14.07%) and 2,461 (21.67%) HBeAg positive results to all active HBV infections and identified chronic infections respectively. Clearance of HBsAg was observed in 5,569 cases, inclusive of clearance in 135 chronic cases. Active HBV infections were significantly higher in men than women over the five years (p < 0.0001). Among individuals who were vaccine-eligible as infants (0 to 19 years old), we observed 4,981 active HBV infections, including 1,131 infections under five years old, majority of which (65.78%) were under one year old. In the under five-year age group, the HBsAg population positivity rate was 0.02% and test positivity rate was 4.83%. Among all women with active HBV infections (78,935), 85.17% were of reproductive age and of these, 13.73% were HBeAg positive. Without a birth dose of the HBV vaccine, lack of routine HBsAg screening at antenatal care, and HBsAg and HBeAg prevalence among women of reproductive age, it is likely that the majority of cases under five years old were vertically infected. Optimal HBV vaccine coverage, inclusive of a birth dose, is key to eliminating horizontal and vertical transmission of HBV. Early identification of HBV chronicity through real time data analysis is fundamental in reducing the risk of liver cirrhosis and hepatocellular carcinoma.

Implementation of Hepatitis B Screening Into Routine Antenatal Care to Prevent Mother-to-Child Transmission in Rural Western Uganda.

In rural Uganda where birth dose vaccination for hepatitis B is not routine, we implemented a pilot program for preventing mother-to-child transmission that effectively identified women with high-risk hepatitis B virus (HBV) infection and started antiviral treatment during pregnancy. Further work is required to enhance antiviral adherence through delivery to ensure effective prevention of vertical HBV transmission.

Intra-Familial Spread of HBV among HbsAg Positive Parents and their Children in a Defined Rural Community of District Peshawar, Pakistan

Background: HBV horizontal and vertical transmission rate vary among population in different social communities. To know the leading cause of HBV transmission among a community would ease the planning and strategies to minimize the spread. The objectives were to determine the frequency of different mode of intra-familial spread of Hepatitis B among the infected index identified families of rural community of Peshawar. Methods: This was 18 months descriptive cross-sectional study conducted among married couples of a defined rural community of district Peshawar. After taking informed consent from 797 couples of rural community, 3 to 5 ml blood sample was collected from each respondents for HbsAg screening along with the required data collected using predesigned questionnaire using convenient sampling techniques. HbsAg positive cases were considered as HBV index. Index case of both Hbs Ag positive parents were decided based on past history, previous exposure, past diagnosis and treatment record. The spouses and children of index cases were screened for serological determinants like HbsAg, HbeAg and ALT. Data was gathered and analyzed using SPSS version 16.0. Results: A total of 797 couples (1593 parents) were selected with proportion of household from ten different blocks of village Budhni. The prevalence of HBV infection among parents was found 1.5%. Nineteen HBV index families were detected among 797 parents screened for HbsAg. Spouse transmission rate of HBV were found 26.3% on average Transmission of HBV infection rate from index mother to children was 11.8%. About 10.5% index females were HbeAg positive. Conclusion: HBV transmission was high among the spouses followed by vertical transmission in a rural community of district Peshawar.

Epidemiology of hepatitis B virus infection among preconception couples in South China: a cross-sectional study

ObjectivesHepatitis B virus (HBV) infection is a global public health threat, and couples of reproductive age comprise a key population in aiming to reduce both the vertical and horizontal transmission...

Modelling of Hepatitis B Virus vertical transmission dynamics in Ethiopia: a compartmental modelling approach

BackgroundHepatitis B (HB) is a virus which causes a potentially fatal liver infection. It is a DNA virus belonging to the Hepadnaviridae virus family. Africa, after Asia, has the second highest number of chronic HBV carriers and is considered a high-endemic region. Ethiopia is classified as a country with a high prevalence of viral hepatitis and with nations that lack a systematic strategy for viral hepatitis surveillance.MethodsS-I-C-R deterministic model was developed and the numerical simulations were done in “R” statistical and programming software. Fixed population assumption was considered so as to develop a simple model which could predict the HBV vertical transmission for the next 5 decades.ResultsThe model revealed that significant number of populations will be infected and become carrier till the end the next 49 years even though it has decreasing trend. It was predicted that 271,719 people will die of HBV complications if no intervention will be made on its vertical transmission. The sensitivity analysis result showed that the force of infection has the most important parameter in the vertical transmission dynamics of hepatitis B. Provision of hepatitis B immunoglobulin (HBVIG) and vaccines at the time of delivery could decrease the force of infection by more than half and 51,892 lives will be saved if the intervention is offered for 50% of deliveries in Ethiopia.ConclusionDespite the fact that the incidence of HBV vertical transmission is substantial, it is expected to decline during the next five decades. However, the situation necessitates immediate attention, since it results in thousands of deaths if no action is taken. Offering HBVIG and vaccinations to the 50% of infants can save many lives and reduces the force of infection by more than a half.

Abstract B067: Trend and factors associated with mothers’ refusal of HBV birth dose to their infants, 2018-2020, Washington metropolitan areas

Abstract Background. Vertical transmission of HBV is the leading mode of acquisition of the infection worldwide. Prevention of vertical transmission is possible in the majority of cases through the correct administration of the birth dose of HBV vaccine to the neonate. The purpose of this study to examine the trend and factors associated with mothers’ refusal of HBV birth dose to their infants in 2018-2020 in the targeted region. Methods. We performed a retrospective analysis of electronic birth dose vaccination of newborns in the 2018-2020. Six birthing facilities and home delivery records sent the birth dose data to the DC Health Department, representing 40,269 newborns. This data from the DC health department has mother’s race and ethnicity, health insurance type, birthing facilities, and mother’s refusal to give her newborn birth dose. Descriptive analysis and multivariable logistic regression analysis were conducted. Results. A total of 34,509 (85.7%) received hepatitis B birth dose within 12 hours or discharge from the facility. Mother’s refusal rate to give her newborn has been significantly decreased from 2018 to 2020 (11.5% in 2018, 8.6% in 2019, and 4.2% in 2020, p&amp;lt;.001). There were racial/ethnic differences in the HepB birth dose rates: Asian newborns (90.4%) had the highest vaccination rate followed by Hispanics (88.7%), Whites (86.1%), and African Americans (84.4%). In multivariate logistic regression analysis, race, birthing facility, and health insurance were associated with mother’s refusal. African American mothers (aOR=1.26, 95% CI: 1.15-1.39) and those with home birth (aOR=4.12, 95% CI: 2.96-5.74) had high likelihood to refuse having birth dose. Those with Medicaid were less likely to refuse than those with private insurance (aOR=0.90; 95% CI: 0.82-0.99). Discussion. Our study indicated that the overall mother’s refusal to give HepB birth dose vaccination rate has decreased in the past 3 years. A policy for universal vaccination of all newborns (regardless of mother’s HBsAg status) should be implemented to prevent unrecognized perinatal transmission. Citation Format: Hee-Soon Juon, Donna Sheler, Jane Pan, Daisy Le, Tony Yang. Trend and factors associated with mothers’ refusal of HBV birth dose to their infants, 2018-2020, Washington metropolitan areas [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B067.

Hepatitis B virus genotype is an independent prognostic factor of telbivudine and tenofovir treatment in hepatitis B surface antigen-positive pregnant women.

To investigate whether HBV genotype influences the effect of tenofovir and telbivudine on HBV DNA and RNA levels in HBsAg‐positive pregnant women. This was a retrospective study of 74 HBsAg‐positive pregnant women in Guizhou of China. All patients were treated with telbivudine or tenofovir from 12 weeks of pregnancy and HBV infection to the date of delivery. Blood samples were collected at 12–24, 28–32, and 36–40 weeks of pregnancy for the measurement of genotype, HBsAg, hepatitis B e antigen (HBeAg), HBV DNA, HBV RNA, and liver function, including alanine transaminase, aspartate transaminase, total bilirubin, total bile acids, cholinesterase, alkaline phosphatase (ALP), and gamma‐glutamyl transferase. All women with HBsAg were followed up. The HBV genotype was B in 64.9% and C in 35.1%. There were 37 patients of telbivudine and tenofovir group respectively. The telbivudine and tenofovir groups showed no differences in demographic and clinical characteristics, including liver function tests, HBsAg, HBeAg, log10(HBV DNA), and log10(HBV RNA). Compared with baseline (12–24 weeks), telbivudine group showed a significant increase in ALP and significant reductions in HBsAg, HBeAg, log10(HBV DNA), and log10(HBV RNA) at 36–40 weeks (p < .05). Tenofovir group exhibited a significant increase in ALP and significant reductions in HBeAg, log10(HBV DNA), and log10(HBV RNA) at 36–40 weeks, compared with baseline (p < .05). HBV genotype (B vs. C) was independently associated with HBV DNA change after therapy (p = .005). In telbivudine group, log10 (HBV DNA) increased from 3.38 (2.00–7.30) to 7.43 (4.68–8.70). In tenofovir group, log10 (HBV DNA) decreased from 7.52 (3.32–8.70) to 2.98 (2.00–5.01). HBV genotype was independently associated with HBV DNA change response to telbivudine or tenofovir in pregnant women with hepatitis B. These findings might be helpful for risk assessment regarding vertical transmission of HBV in HBeAg‐positive mothers treated with nucleos(t)ide analogues.

Risk Factors for Hepatitis B Virus Transmission in Oman.

ObjectivesHepatitis B virus (HBV) is a major public health problem worldwide. The prevalence of HBV is dependent on the modes of transmission. Chronic hepatitis B (CHB) infection can progress to liver cirrhosis and hepatocellular carcinoma. Oman is regarded as an intermediate endemic region and has had a neonatal vaccine against HBV since 1990. However, little research has been conducted regarding risk factors for HBV transmission. Our study aimed to identify the prevalence of major risk factors for acquiring HBV in Oman.MethodsWe conducted a retrospective chart review of all adult Omani patients diagnosed with CHB at two tertiary hospitals in Oman, Sultan Qaboos University Hospital and Armed Forces Hospital, between February 2009 and July 2013. The prevalence of major risk factors was identified by interviewing CHB patients using a standard questionnaire during their follow-up visits to the hepatology clinic at both hospitals. The risk factor frequency was stratified by age, gender, and educational level.ResultsA total of 274 patients were interviewed; 52.2% of the participants were males. The median age for men was 35.9 years and 35.1 years for women, with 75.5% aged 20–39 years old. The antenatal screening was the most common means of identifying HBV infection in females, and pre-blood donation screening was the most common in males. Intra-familial contact with HBV infected persons and behavioral risks such as body piercing (females) and barber shaving (males) were more common than nosocomial risk factors. Knowledge about HBV infection was scarce among our participants. More than half of the participants had a positive family history of HBV infection. There was a significant association between HBV infection and age groups, and educational levels (p < 0.050 and p < 0.001, respectively). Among those who were infected due to intra-familial contact or behavioral risk, there was a significant difference between the two sexes (p < 0.020) and between the three age groups (< 23, 23–28, >28) of HBV positive mothers (33.3%, 14.3%, and 6.6%, respectively; p < 0.050). There was also a statistically significant difference among different educational levels (p < 0.050).ConclusionsDirect contact of infected individuals within a family and exposure to high-risk behaviors such as piercing and barber shaving are the main reported risk factors for HBV infection in Omani patients. Reducing the vertical and horizontal transmission of HBV in Oman could be improved by implementing routine antenatal screening of pregnant women and a greater focus on contact screening, respectively.

Comparative Analysis of the Vertical Risk of Transmission of Some Blood-Borne Infections in the Republic of Guinea

The aim of our work was to compare the HBV, HCV and HIV vertical transmission risk in the Republic of Guinea.Materials and methods. The material for the study was 305 blood plasma samples from pregnant women living in Conakry, Republic of Guinea. The samples were examined for the presence of serological (HBsAg, antibodies antiHBs IgG, anti-HBcore IgG, anti-HCV IgG, Ag/Ab-HIV) and molecular (HBV DNA, HCV RNA, HIV RNA) markers.Results and discussion. When assessing the overall prevalence of serological markers among patients, the incidence of HBV markers was 76.06 %. Antibodies to HCV were detected only in 1 case, which amounted to 0.32 %. HIV markers were detected in 3 cases, which amounted to 0.98 %. The prevalence of HBsAg in the group under examination significantly differed between the groups of pregnant women aged 13–19 years (17.33 %) and 20–24 years (12.12 %), p&lt;0.0001, RR=5.107 with 95 % CI: 2.458–10.612. When assessing the overall prevalence of molecular-biological markers among patients, we did not detect HIV RNA, in one patient, HCV RNA was determined, which was 0.32 %, while the incidence of HBV DNA was 20 %. Among HBsAg-positive individuals, HBV DNA was detected in 86.11 %, which was 10.16 % of the total group. Among the HBsAg-negative individuals, HBV DNA was detected in 11.15 % (9.84 % of the total group). It should be noted that in nine cases, HBV DNA was detected without any serological markers, which amounted to 14.75 % (2.95 % of the total group). Assessment of the blood-borne infections prevalence in pregnant women is significant for the subsequent identification of pathogen transmission routes in order to control and/or prevent the spread of infection.

Screening of hepatitis B in high risk Chilean and immigrant pregnant women: Management of mother to child transmission

Chile is a low-endemic HBV country, but countries with the highest migratory flow to Chile have an intermediate-high endemicity. In order to avoid vertical transmission of HBV, immunoprophylaxis (IP) in the newborn (NB) is a key factor. To identify HBsAg prevalence in pregnant immigrants and Chilean pregnant women with risk behaviors (RB) and to asses IP use in the NB. Prospective HBsAg screening cohort of immigrant and Chilean pregnant women with RB, between July 1, 2017 and June 30, 2018 in CABL. IP of all NB of reactive HBsAg mothers was assessed. 1,415 HBsAg samples, 1,265 immigrants and 150 Chileans with RB. 37 reactive HBsAg. Two false positive. HBsAg prevalence in immigrant pregnant women was 2.7% and 0.66% in Chileans with RB (p < 0.05). 91.1% came from Haiti, with a prevalence of 3.5% in our region. All NB (36) received IP with a median of administration of 3:02 h. The prevalence in immigrant pregnant women was higher than that reported in the general population and in Chilean women with RB. We proposed the need for universal screening in pregnancy, especially in pregnant women from countries with intermediate-high endemicity.

Important role of study on intrauterine transmission of HBV in prevention and control of hepatitis B

The new research of intrauterine transmission of HBV includes intrauterine dominant infection and occult infection. Intrauterine dominant infection of HBV is the traditional intrauterine infection. Although intrauterine infection of HBV has been studied for decades, the intervention effects on HBV infection are very limited. As a result, mother to child transmission has become the main route of the transmission of HBV. With the development of science and technology, people's understand of intrauterine occult infection of HBV has been deepened, and the definition of intrauterine transmission of HBV has been further completed and expanded. The study of intrauterine occult infection of HBV will play an important role in prevention and control of hepatitis B in China through filling in a gap in the field of prevention and control of vertical transmission of HBV, exploring new research perspective and providing guideline for related decision-making.

Presence of Precore (C)/C Promoter Mutants in Peripheral Blood Mononuclear Cells of Chronic Hepatitis B (CHB) Carriers During Pregnancy Does Not Correlate with Increased Risk of Liver Disease in 4Years of Follow-Up.

HBV precore (PC) and basal core promoter (BCP) mutants are associated with liver disease severity, yet have been suggested to protect against HBV vertical transmission. HBV within peripheral blood mononuclear cells (PBMC) has been reported in association with intrauterine HBV infection. We analyzed HBV replication status in PBMC and PC/BCP mutants in PBMC from pregnant chronic hepatitis B (CHB) patients. Pregnant CHB carriers were assessed for HBeAg, HBV-DNA, ALT in second-third trimester and liver stiffness measurement (LSM) postpartum. HBV-DNA, HBV-cccDNA, and HBV-mRNA were tested in PBMC by in-house PCR. BCP/PC variants were determined by Sanger sequencing and analyzed using MEGA7. In 37 CHB pregnant carriers, median age 32years, 53% Asian, median ALT 19 versus 26U/L, median HBV-DNA 2.6 versus 8.1logIU/mL (untreated vs. treated), eight HBeAg+, with genotype 10%A, 29%B, 21%C, 10%D, 19%E, eight received tenofovir in pregnancy to reduce vertical transmission risk. HBV-DNA was detected in ~ 55% (25/45) PBMC, and PC/BCP mutations were found in 36% (9/25) and 4% (1/25), respectively. All infants received HBV immunoprophylaxis and tested HBV surface antigen negative at 9-12months of age. During a median 4years (IQR 3-5), follow-up all mothers showed normal LSM, with no significant change in ALT, HBeAg status, or HBV-DNA levels compared to baseline in untreated CHB carriers. In this multiethnic cohort of pregnant CHB carriers, HBV replicative intermediates and PC/BCP mutants were found in significant proportion of PBMC, but were not associated with increased risk of HBV immunoprophylaxis failure or liver disease severity over long-term follow-up.

A retrospective serological survey of hepatitis B virus infection in Northeast China

BackgroundHepatitis B virus (HBV) infection is a major public health burden in China although it has steadily declined over the last two decades. A valid updated prevalence of HBV infection in China relies on a large sample size. Hence this study aimed to estimate HBV seroprevalence using a large inpatient population in Northeast China.MethodsWe consecutively enrolled 218,627 inpatients aged 1–70 years admitted to the First Hospital of Jilin University from January 2010 through December 2014. HBV serological markers were detected by chemiluminescence immunoassay (CLIA).ResultsAmong the 218,627 collected samples, 16,254 (7.43%) were positive for HBsAg and 41.64% of patients were negative for all the HBV markers. The highest HBsAg prevalence was 10.05% in the 41–50 year age group and the lowest were 0.47% in the 1–10 and 2.35% in the 11–20 year age groups, respectively. HBsAg positivity was higher in males compared to females (8.94% vs. 5.80%). An HBsAg positivity of nearly 14% was found in middle-aged males, and positivity was 6.2% in females of childbearing age. One-third of this population only had a single HBsAb marker, which was also detected in 60% of patients aged under 20 years.ConclusionThough universal hepatitis B vaccination of infants has significantly reduced HBsAg prevalence in children, the number of most adults who have been infected with HBV remains steady. Extra care and resources should be provided to HBV-infected middle-aged males to stop the progression of chronic hepatitis B, and HBsAg positive females of childbearing age to block vertical HBV transmission.

Investigation of the risk factors associated with the failure of hepatitis B vaccination of neonates in Yunnan province, China

ObjectiveThis study aimed to investigate HBsAg positive rates and risk factors of HBV infection among the children less than 15 years old in Yunnan province, a remote southwest part of mainland China. MethodsMulti-stage sampling was used to randomly select study subjects from 9,360,000 individuals. Hepatitis B vaccine inoculation rate and HBsAg positive rate were investigated, and then propensity score and generalized linear mixed model (GLMMs) were applied to the case-control study. ResultsThe average HBsAg positive rate was 1.81%, with 1.2% in urban areas and 2.4% in rural areas. Rate of first-dose-in-time in urban areas was 77.7%, obviously higher than 49.5% in rural areas (χ2=2811.71, P<0.01). Similarly, 3-dose completion coverage rate in urban areas was 93.7%, also higher than 79.0% in rural areas (χ2=1561.43, P<0.01). Maternal HBeAg positivity and HBsAg positivity were proved to be the main risk factors of children with HBV infection. Moreover, paternal HBeAg positivity, paternal HBsAg positivity, the absence and unknown status of HBV vaccine inoculation were risk factors of children with HBV infection as well. ConclusionIt was very important to improve the HBV vaccine inoculation rates. Delivering babies in hospital and timely inoculation with HBV vaccine were efficient ways to prevent HBV vertical transmission.

Efficacy and safety of tenofovir in preventing mother-to-infant transmission of hepatitis B virus: a meta-analysis based on 6 studies from China and 3 studies from other countries

BackgroundThe vertical transmission of HBV from mothers to their infants at birth or in early infancy has a significant role in the endemicity of HBV infection. Tenofovir is one of the most potent anti-HBV agents with a high genetic barrier to resistance. The study is to evaluate the efficacy of tenofovir in preventing perinatal HBV transmission, as well as monitoring safety for mothers and infants.MethodsPubMed, Embase, Web of Science, and CNKI (National Knowledge Infrastructure, China) database were systematically reviewed for studies that compared the efficacy and safety of tenofovir with other treatments. Pooled estimates were expressed with weight mean difference (WMD) with 95% confidence intervals (95% CIs) and risk ratio (RR) with 95% CIs.ResultsNine studies involving 1046 pregnant patients met the inclusion criteria and were included in this meta-analysis. Compared with other treatments, tenofovir significantly reduced maternal HBV DNA levels (WMD = 2.33 log10 IU/mL, 95% CI: 1.01, 3.64; P < 0.001), infant HBsAg positivity rate (RR = 0.25, 95% CI: 0.16, 0.38; P < 0.001), infant HBeAg positivity rate (RR = 0.26, 95% CI: 0.14, 0.48; P < 0.001), infant HBV DNA positivity rate (RR = 0.15, 95% CI: 0.07, 0.31; P < 0.001), and immunoprophylaxis failure rate (RR = 0.31, 95% CI: 0.13, 0.73; P = 0.008). Moreover, maternal and infant safety profiles, including ALT, CK, and Cr were comparable between tenofovir and other treatment groups.ConclusionBased on the current evidence, our study suggested that tenofovir significantly reduced the rate of vertical transmission of HBV, as well as the HBV DNA levels in HBV-infected mothers. Moreover, tenofovir was safe and tolerable for both mothers and their infants.

Immune-escape mutations and stop-codons in HBsAg develop in a large proportion of patients with chronic HBV infection exposed to anti-HBV drugs in Europe

BackgroundHBsAg immune-escape mutations can favor HBV-transmission also in vaccinated individuals, promote immunosuppression-driven HBV-reactivation, and increase fitness of drug-resistant strains. Stop-codons can enhance HBV oncogenic-properties. Furthermore, as a consequence of the overlapping structure of HBV genome, some immune-escape mutations or stop-codons in HBsAg can derive from drug-resistance mutations in RT. This study is aimed at gaining insight in prevalence and characteristics of immune-associated escape mutations, and stop-codons in HBsAg in chronically HBV-infected patients experiencing nucleos(t)ide analogues (NA) in Europe.MethodsThis study analyzed 828 chronically HBV-infected European patients exposed to ≥ 1 NA, with detectable HBV-DNA and with an available HBsAg-sequence.The immune-associated escape mutations and the NA-induced immune-escape mutations sI195M, sI196S, and sE164D (resulting from drug-resistance mutation rtM204 V, rtM204I, and rtV173L) were retrieved from literature and examined. Mutations were defined as an aminoacid substitution with respect to a genotype A or D reference sequence.ResultsAt least one immune-associated escape mutation was detected in 22.1% of patients with rising temporal-trend. By multivariable-analysis, genotype-D correlated with higher selection of ≥ 1 immune-associated escape mutation (OR[95%CI]:2.20[1.32–3.67], P = 0.002). In genotype-D, the presence of ≥ 1 immune-associated escape mutations was significantly higher in drug-exposed patients with drug-resistant strains than with wild-type virus (29.5% vs 20.3% P = 0.012). Result confirmed by analysing drug-naïve patients (29.5% vs 21.2%, P = 0.032). Strong correlation was observed between sP120T and rtM204I/V (P < 0.001), and their co-presence determined an increased HBV-DNA.At least one NA-induced immune-escape mutation occurred in 28.6% of patients, and their selection correlated with genotype-A (OR[95%CI]:2.03[1.32–3.10],P = 0.001).Finally, stop-codons are present in 8.4% of patients also at HBsAg-positions 172 and 182, described to enhance viral oncogenic-properties.ConclusionsImmune-escape mutations and stop-codons develop in a large fraction of NA-exposed patients from Europe. This may represent a potential threat for horizontal and vertical HBV transmission also to vaccinated persons, and fuel drug-resistance emergence.

Patterns of serologic markers of hepatitis B virus infection and the risk of transmission among pregnant women in southwestern Nigeria

ABSTRACTHepatitis B virus (HBV) infection is a major health concern in developing countries that has a high morbidity and mortality rate. Vertical transmission of HBV from mother to child has been identified as a major factor leading to chronicity with attendant liver conditions, especially in poor socioeconomic settings. This study aims to evaluate the prevalence of serological HBV markers among pregnant women in Ibadan southwestern Nigeria and to determine the implications for perinatal HBV transmission. This study revealed the presence of varied HBV serological patterns of infection or immunity among pregnant women in Ibadan, Nigeria, and thus the risk of mother to child transmission.

Cesarean section to prevent mother-to-child transmission of hepatitis B virus in China: A meta-analysis

BackgroundHepatitis B virus (HBV) is predominantly transmitted through mother-to-child transmission (MTCT). To date, it remains unclear whether the method of parturition affects MTCT of HBV. In order to clarify whether cesarean section, when compared with vaginal delivery, could reduce the risk of MTCT of HBV in China, we conducted this meta-analysis.MethodsA systematic literature search was performed of the PubMed (Medline), Embase, ISI Web of Science, China Biological Medicine Database, China National Knowledge Infrastructure, and VIP Database for Chinese Technical Periodicals databases for articles written in English or Chinese through July 2015.The reference lists of relevant articles were also scrutinized for additional papers. Randomized controlled trials, cohort studies, or case-control studies investigating the effect of delivery mode on MTCT of HBV were included.ResultsThis analysis involved 28 articles containing 30 datasets. The data encompassed 9906 participants. The MTCT rate of HBV was 6.76% (670 of 9906) overall, with individual rates of 4.37% (223 of 5105) for mothers who underwent cesarean section and 9.31% (447 of 4801) for those who underwent vaginal delivery. The summary relative risk (RR) was 0.51 (95%CI: 0.44–0.60, P < 0.001), indicating a statistically significant decrease in HBV vertical transmission via cesarean section compared with vaginal delivery. The heterogeneity among studies was moderate with an I2of29.3%.Publication bias was not detected by the Egger’s and Begg’s tests, and the funnel plot was symmetric. In the subgroup analyses, maternal hepatitis B e antigen status and follow-up time did not affect the significance of the results, but hepatitis B immune globulin (HBIG) administration to mother and infant did.ConclusionsCesarean section could reduce the risk of MTCT of HBV in comparison to vaginal delivery in China. However, owing to several limitations of our meta-analysis, future well-designed randomized controlled trials with adequate statistical power, might be a more appropriate next step.

A survey of HIV, HBV and HCV infections in children aged 1-13 years in Yi ethnic area, Sichuan province

Objective: To investigate the prevalence of HIV, HBV and HCV infections in children aged 1-13 years in Yi ethnic area in Sichuan province. Methods: A cross-sectional study was conducted in the form of field survey in four townships selected from Yi ethnic area of Sichuan during 2014-2015. Participants were children aged 1-13 years by sample size of 900 and were screened for HIV antibody, HBV surface antigen and HCV antibody, and laboratory comfirmation was conducted. The area, age, gender and ethnic group specific infection rates were compared by using Fisher's exact test, and multiple comparisons were corrected by using Bonferroni correction. Results: A total of 677 children aged 1-13 years were surveyed. The infection rates of HIV, HBV and HCV were 1.03% (7/677, 95%CI: 0.42%-1.12%), 6.65% (45/677, 95%CI: 4.89%-8.79%) and 0.15% (1/677, 95%CI: 0%-0.82%), respectively. The infection rates of HIV differed among townships (P=0.000), the infection rate was higher in township D than in township B, the difference was significant (P<0.001). The differences in HIV infection rate among different age, gender and ethnic groups were not significant. The differences in HBV and HCV infections were not significant among different townships, age, gender and ethnic groups. The difference in HBV viral load between age group 5-9 years and age groups 10-13 years was not significant (U=115.000, P=0.967). Conclusions: The burden of HIV and HBV infections in children aged 1-13 years was heavy in rural area of Yi ethnic area in Sichuan. Therefore, it is necessary to take effective measures to block the vertical transmission of HIV and HBV as well as to increase the coverage of HBV vaccination.