Quantitative maternal hepatitis B surface antigen predicts maternally transmitted hepatitis B virus infection

Abstract

Quantitative maternal HBsAg predicts infection in infants as well as maternal viral load does. Antiviral therapy may be considered in pregnant women with an HBsAg level above 4-4.5 log IU/mL to interrupt mother-to-infant transmission. (Hepatology 2016;64:1451-1461).

Mother‐to‐child transmission of hepatitis B: Examining viral cut‐offs, maternalHBsAg serology and infant testing

“…In the setting of pregnancy, Sun et al reported a sensitivity of 85.1%, specificity of 96.5%, PPV of 98.8% and NPV of 65.9% in using qHBsAg >4.1 log IU/mL to predict viral load >7.0 log IU/mL. Wen et al reported that in 526 mother‐infant pairs that a quantitative HBsAg could be used to predict a significant risk of immune prophylaxis failure as well as high maternal viral load. A quantitative HBsAg of 4.1 log10 IU/mL predicted maternal viral load of 5.95 log10 IU/mL with sensitivity of 100% and specificity of 71% .…”

“…HBsAg quantitation is a cheaper ($15 AU) alternative to HBV DNA. In a large cohort from Taiwan, Wen et al reported a strong positive correlation between quantitative HBsAg levels and maternal viral load, and with MTCT. In that study, a HBsAg value >4.1 log 10 IU/mL had sensitivity 100% and specificity 71.3% for predicting transmission.…”

“…The presence of HBeAg is a marker of high viral replication, and may have a role in predicting risk of MTCT and need for AVT . Mechanistically, HBeAg is transferred across the placenta and may influence fetal immunotolerance .…”

EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection

“…[198][199][200][201] NA prophylaxis could be also useful in the few HBeAg-negative women with high levels of viremia but normal ALT levels. [198][199][200][201] These mothers should be informed that utilising a NA to reduce their viremia levels increase the effectiveness to HBIG and vaccination. LAM, TBV or TDF prophylaxis has been used in this setting during the last trimester of pregnancy.…”

Bringing to an end mother‐to‐child transmission of hepatitis B: A role for quantitative hepatitis B surface antigen?

“…A growing body of data suggest that maternal treatment with nucleoside analogs in the third trimester of pregnancy, in addition to HBV vaccine, and given the very limited access to HBIG for the infant, may reduce MTCT of HBV as well as offset the effect of imperfect adherence to infant vaccination schedules in many settings, as well as the absence of the initial birth dose of vaccine in highly viremic mothers. Wen et al provide evidence that quantitative HBsAg testing may provide a simpler test to facilitate the prevention of perinatal transmission of hepatitis B infection …”