Chronic Hepatitis B Virus Infection and Pregnancy

Abstract

Planning of pregnancy and management of chronic hepatitis B virus during pregnancy includes recognition of maternal virological status, assessment of liver disease severity and minimization of risk for mother to infant transmission of infection. Decisions regarding the use of antivirals during pregnancy need to be individualized. Monitoring for infection and immunization in newborns is also important. For mothers on antiviral therapy, breastfeeding is not recommended. ( J CLIN EXP HEPATOL 2012;2:366-381) A pproximately 400 million people are chronically infected with hepatitis B virus (HBV) worldwide, 1 and almost half have acquired their infections either through mother to infant transmission or in early childhood, especially in countries where HBV has intermediate to high prevalence.2 In Asia, 8%-10% of the population is chronically infected with HBV, and up to 50% of new cases of hepatitis B infection are due to mother to infant transmission.3 In contrast, the majority of new hepatitis B cases in developed countries are the result of horizontal transmission in adulthood. Before the adoption of standard passive-active immunoprophylaxis treatment, approximately 70%-90% of infants born to hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg) positive mothers became chronically infected with HBV. 4 The mother to infant transmission rate was reduced to 5%-10% when infants received appropriate postnatal hepatitis B immunoglobulin (HBIg) and a series of HBV vaccines. However, despite passive-active immunoprophylaxis provided to infants, up to 8%-30% of infants born to highly viremic mothers still become infected with HBV (Figures 1-3). This review will address several issues important to chronic hepatitis B virus infection and pregnancy including effect of pregnancy on chronic HBV infection, effect of chronic HBV infection on pregnancy, mother to infant transmission, safety data on HBV antivirals during pregnancy, management of chronic HBV infection in women who desire pregnancy or become pregnant while taking antivirals. PREVALENCE OF CHRONIC HEPATITIS B VIRUS INFECTION AMONG PREGNANT WOMEN IN INDIAThe prevalence of chronic HBV infection varies widely, with rates ranging from 0.1% to 20% in different parts of the world.2 "High" prevalence (HBsAg positivity rates > 8%) regions include the Asia (except Japan), parts of the Middle East, sub-Saharan Africa, and the Amazon basin. "Intermediate" (2%-7% HBsAg positive) prevalence regions include, the Indian subcontinent, parts of central Asia and the Middle East, Eastern and Southern Europe, as well as parts of South America. "Low" prevalence (<2% HBsAg positive) regions include the United States, Northern Europe, Australia, Japan and the southern part of South America. Overall, 45% of the world population lives in "high" prevalence regions.The HBsAg positivity rate of Hepatitis B in India is different in the different regions of the country. The overall chronic HBsAg positivity rate is often quoted as being 4.7%.5 In India, the prevalence rate of HBsAg...

Hepatitis B and HIV co-infection in pregnant women: Indication for routine antenatal hepatitis B virus screening in a high HIV prevalence setting

“…The FDC ARV regimen (TDF/ FTC/EFV) currently recommended for all HIV-positive pregnant women benefits the mother with HBV co-infection and also offers protection against HBV infection to the exposed neonate by reducing the maternal HBV DNA load, which is an independent risk factor for perinatal transmission. [5,10,11] This strategy provides a great advantage over the past zidovudine and single-dose nevirapine (NVP) PMTCT regimen in which a single postpartum dose of TDF and FTC was given. [12] While this was intended to protect the mother from developing NVP resistance, it offered no benefit to the mother or her exposed neonate if she was also HBV-infected.…”

“…The use of antenatal ARVs against hepatitis B has been shown to be relatively safe and may compensate for immunoprophylaxis failure, especially in resource-limited settings where early access to immunisation is not always available. [5,10,13] The new national PMTCT guidelines recommend maternal HBV screening of all HIV-infected women receiving FDC prior to discontinuing the prophylactic ARV regimen at cessation of breastfeeding. [4] This strategy protects HBV/HIV co-infected women from developing hepatitis flares.…”

Diagnostic Value of the Quantitative Titer of High-Sensitivity C-Reactive Protein in the Detection of Clinical Stages of Chronic Hepatitis B Infection

“…Unlike most infected infants and children developing chronic infection, most infected adults can overcome HBV infection without facing any problems (2,3).…”

Hepatobiliary Quiz-5 (2013)

“…1 Due to pregnancy related immunosupression there is an overall increase in median HBV DNA levels and decreased alanine aminotransferase (ALT) levels. A significant increase in liver disease activity after pregnancy, defined as a three times increase in alanine aminotransferase (ALT) occurs in 45% of patients within 6 months after delivery.…”

“…85-95% of infected infants will become chronic HBV carriers. 1 The mother to infant transmission rate is reduced to 5%-10% after postnatal hepatitis B immunoglobulin (HBIg) and a series of HBV vaccines. Serum HBV deoxyribonucleic acid (DNA) level has been identified as the single most important predictor and independent risk factor for transmission.…”