Efficacy and safety of tenofovir disoproxil fumarate in pregnancy to prevent perinatal transmission of hepatitis B virus

Greenup, Astrid-Jane; Tan, Pok Kern; Nguyen, Vi; Glass, Änne; Davison, Scott A.; Chatterjee, Ushmi; Holdaway, Susan; Samarasinghe, Dev; Jackson, Kathy Merlock; Locarnini, Stephen; Levy, Miriam

doi:10.1016/j.jhep.2014.04.038

Cited by 156 publications

(208 citation statements)

References 50 publications

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“…Perinatal transmission was reduced to 0 and 2% in the lamivudine and tenofovir cohorts, respectively, compared with 20% in the untreated groups. No diff erences were noted in obstetric or infant safety outcomes ( 110 ). Although some studies have suggested a favorable safety profi le for antiviral therapy even in the fi rst and second trimesters of pregnancy, when utilized purely for purposes of reducing MTCT, antiviral therapy should be initiated in the third trimester (thus minimizing the risk associated with fetal exposure to these medications).…”

Section: Hepatitis C (Hcv)mentioning

confidence: 99%

ACG Clinical Guideline: Liver Disease and Pregnancy

Tran

Ahn

Reau

2016

American Journal of Gastroenterology

235

257

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Consultation for liver disease in pregnant women is a common and oftentimes vexing clinical consultation for the gastroenterologist. The challenge lies in the need to consider the safety of both the expectant mother and the unborn fetus in the clinical management decisions. This practice guideline provides an evidence-based approach to common diagnostic and treatment challenges of liver disease in pregnant women. Am J Gastroenterol 2016; 111:176-194; doi: 10.1038/ajg.2015 Initial evaluation of pregnant patientA pregnant patient presenting with abnormal liver tests should undergo standard workup as with any non-pregnant individual (strong recommendation, very low level of evidence). Imaging in pregnancyUltrasound is safe and the preferred imaging modality used in assessment of abnormal liver tests suggestive of biliary tract disease (strong recommendation, low level of evidence).Magnetic resonance imaging without gadolinium can be used in the second and third trimester (conditional recommendation, low level of evidence).Computed tomography scans carry a risk of teratogenesis and childhood hematologic malignancies but may be used judiciously with minimized radiation protocols (2-5 rads; conditional recommendation, very low level of evidence). Endoscopy in pregnancyEndoscopy is safe in pregnancy but should be deferred until the second trimester if possible (strong recommendation, low level of evidence).Meperidine and propofol can be used for endoscopic sedation (strong recommendation, moderate level of evidence). Management of biliary disease in pregnancyERCP can be performed when indicated for pregnant women presenting with biliary disease that strongly necessitates intervention such as biliary pancreatitis, symptomatic choledocholithiasis, and/or cholangitis. Minimizing fetal exposure to fl uoroscopy is imperative (strong recommendation, low level of evidence).Symptomatic cholecystitis should be managed with early surgical intervention with laparoscopic cholecystectomy (strong recommendation, low level of evidence). Liver masses in pregnancyAsymptomatic hemangioma and focal nodular hyperplasia do not need routine imaging or surveillance during pregnancy (strong recommendation, very low level evidence).Hepatic adenomas should be monitored with ultrasound during pregnancy for growth. Patients with large adenomas (>5 cm) should be referred for resection prior to pregnancy (strong recommendation, low level of evidence). Hepatitis B in pregnancyActive-passive immunoprophylaxis with hepatitis B immunoglobulin and the HBV vaccination series should be administered to all infants born to HBV-infected mothers to prevent perinatal transmission (strong recommendation, low level of evidence).Women chronically infected with HBV and high viral load (>10 6 log copies/ml (200,000 IU/ml) and higher) should be offered antiviral medication with tenofovir or telbivudine in the third trimester to reduce perinatal transmission of HBV (strong recommendation, low level of evidence).C-section should not be performed electively in HBV-pos...

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Section: Hepatitis C (Hcv)mentioning

confidence: 99%

ACG Clinical Guideline: Liver Disease and Pregnancy

Tran

Ahn

Reau

2016

American Journal of Gastroenterology

235

257

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“…1 Among the last two agents, TDF should be preferred, because it has a better resistance profile and more extensive safety data in pregnant HBV positive women. 1,[196][197][198] In a woman of childbearing age without advanced fibrosis who plans a pregnancy in the near future, it may be prudent to delay therapy until the child is born. In a woman of childbearing age with advanced fibrosis or cirrhosis who agrees for a ''planned pregnancy'' in the future, PegIFNa therapy may be tried as it is given for a finite duration.…”

Section: Pregnancy Recommendationsmentioning

confidence: 99%

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

Lampertico¹,

Agarwal²,

Berg³

et al. 2017

Journal of Hepatology

4,013

3,081

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“…First, pregnant women with high (>10 6-7 IU/mL) HBV DNA levels have an increased (>10 %) risk of vertical HBV transmission despite HBV immunoglobulin administration and vaccination [13][14][15]. Thus, it is recommended that they receive oral antiviral therapy during the last trimester of their pregnancy [1••].…”

Section: Hbeag-positive Patients In the Immunotolerant Phasementioning

confidence: 99%

“…Thus, it is recommended that they receive oral antiviral therapy during the last trimester of their pregnancy [1••]. In such patients, treatment with LAM, TBV, or TDF during this period, alongside passive and active immunization of the newborn, has been shown to be safe and to reduce the probability of intrauterine and perinatal HBV transmission [13][14][15]. If NA therapy is given only for the prevention of perinatal transmission, it is usually discontinued within the first 3 months after delivery [1••], but close follow-up of the mothers should continue, in order to detect possible postpartum flares [16].…”

Section: Hbeag-positive Patients In the Immunotolerant Phasementioning

confidence: 99%

Controversial Issues in Current Treatment of Chronic HBV Infection

Siakavellas

Papatheodoridis

2015

Curr Hepatology Rep

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The management of patients with progressive chronic hepatitis B infection (CHB) has undergone dramatic changes in the last decade, with the introduction of newer and more potent agents. Detailed international guidelines exist that provide advice for the optimal care of CHB patients. Despite that, several topics such as optimal treatment indication, choice of treatment type, and the discontinuation of nucleos(t)ide analogue therapy remain controversial, as relevant recommendations and expert opinions often vary widely. This review addresses these topics in more detail aiming to provide some clarifications taking into account the most recent data from the available literature.

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Efficacy and safety of tenofovir disoproxil fumarate in pregnancy to prevent perinatal transmission of hepatitis B virus

Cited by 156 publications

References 50 publications

ACG Clinical Guideline: Liver Disease and Pregnancy

ACG Clinical Guideline: Liver Disease and Pregnancy

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

Controversial Issues in Current Treatment of Chronic HBV Infection

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