Hepatitis B and C in pregnancy: a review and recommendations for care

Dunkelberg, Jeffrey C.; Berkley, Eliza; Thiel, Kristina W.; Leslie, Kimberly K.

doi:10.1038/jp.2014.167

Cited by 89 publications

(82 citation statements)

References 103 publications

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“…The study results help in better understanding of the overall epidemiology of HCV in the state of New York. Maternal transmission of HCV is the leading cause of pediatric chronic HCV [8]. HCV screening is not recommended universally for all pregnant women.…”

Section: Discussionmentioning

confidence: 98%

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Hepatitis C Seroprevalence Among HIV-Infected Childbearing Women in New York State in 2006

Ghazaryan

Smith

Parker

et al. 2015

Matern Child Health J

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Objective To identify factors associated with maternal hepatitis C virus (HCV) seroprevalence and transmission of HCV as identified by qualitative HCV ribonucleic acid (RNA) in the infants of human immunodeficiency virus (HIV) infected women delivering in New York State (NYS) in 2006. Study Design In this retrospective cohort study of HIV-exposed infants born in NYS, leftover infant plasma from HIV diagnostic testing was deidentified and tested for HCV. If HCV antibodies were detected, a second specimen collected when the infant was [2 months old was tested for HCV qualitative RNA. Multivariate logistic regression was used to identify factors associated with HCV seropositivity. Results In a final sample of 553 live birth events with perinatal HIV exposure, 21 (3.8 %) of tested infant specimens had HCV antibodies indicative of maternal HCV seropositivity.Maternal age at delivery of [35 years, Hispanic ethnicity, white race and injection drug use (IDU) were significantly associated with HCV seropositivity in multivariate analysis. No cases of HCV vertical transmission were identified among HCV exposed infant specimens. Conclusions This statewide population-based study of HIV-infected childbearing women shows HCV seroprevalence of 3.8 %. Maternal age of [35 years and IDU are the strongest predictors of HCV seropositivity. Although no viral transmission was documented, more comprehensive longitudinal testing would be required to conclude that HCV transmission did not occur. SignificanceThis statewide population-based study of HIV-infected childbearing women shows HCV seroprevalence of 3.8 %.The study results help in better understanding of the overall epidemiology of HCV and reinforce the current HCV screening recommendations among pregnant women infected with HIV. The identified seroprevalence of HCV may raise awareness among health care providers and ensure appropriate HCV screening and early identification of HCV among HIV infected women of childbearing age (15-45 years old).

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Section: Discussionmentioning

confidence: 98%

“…Among pregnant women with a history of IDU, the HCV prevalence is estimated to be 70-95 % [7]. The prevalence of HCV among HIV-infected pregnant women has been reported to be 17-54 % [8].…”

Section: Introductionmentioning

confidence: 99%

Hepatitis C Seroprevalence Among HIV-Infected Childbearing Women in New York State in 2006

Ghazaryan

Smith

Parker

et al. 2015

Matern Child Health J

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“…Therefore, the blood in the mothers contained at least 6 log copies/mL of the G145R mutant, which represents a high viral load. The maternal viral load is well known as the most significant contributor to breakthrough infection in MTCT [7, 10, 37]. Before this investigation was performed, we speculated that the HBV DNA levels of VEMs could also be one of the most influential factors for breakthrough infection.…”

Section: Discussionmentioning

confidence: 99%

“…The protection rate of MTCT with the HB vaccine plus HBIG and vaccine alone was reported to be 94% and 75%, respectively [2]. Although immunoprophylaxis with the combination of HB vaccine and HBIG is highly effective for the prevention of MTCT, 5% to 10% of infants born to HBeAg/HBsAg-positive mothers become infected despite adequate immunoprophylaxis [3–7]. Apart from improper immunization, a high level of maternal viraemia is considered to be the main cause of immunoprophylaxis failure [5, 6, 8–12].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the G145R Mutant of the Hepatitis B Virus as a Minor Strain in Mother-to-Child Transmission

et al. 2016

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The role of the hepatitis B virus (HBV) mutant G145R, with a single change in amino acid 145 of the surface protein, as a minor population remains unknown in mother-to-child transmission. The minor strain as well as the major strain of the G145R mutant were evaluated in three cohorts using a locked nucleic acid probe-based real-time PCR. The breakthrough cohort consisted of children who were born to HBV carrier mothers and became HBV carriers despite immnoprophylaxis (n = 25). The control cohort consisted of HBV carriers who had no history of receiving the hepatitis B vaccine, hepatitis B immunoglobulin or antiviral treatment (n = 126). The pregnant cohort comprised pregnant women with chronic HBV infection (n = 31). In the breakthrough cohort, 6 showed positive PCR results (major, 2; minor, 4). In the control cohort, 13 showed positive PCR results (major, 0; minor, 13). HBeAg-positive patients were prone to have the G145R mutant as a minor population. Deep sequencing was performed in a total of 32 children (PCR positive, n = 13; negative, n = 19). In the breakthrough cohort, the frequency of the G145R mutant ranged from 0.54% to 6.58%. In the control cohort, the frequency of the G145R mutant ranged from 0.42% to 4.1%. Of the 31 pregnant women, 4 showed positive PCR results (major, n = 0; minor, n = 4). All of the pregnant women were positive for HBeAg and showed a high viral load. Three babies born to 3 pregnant women with the G145R mutant were evaluated. After the completion of immunoprophylaxis, 2 infants became negative for HBsAg. The remaining infant became negative for HBsAg after the first dose of HB vaccine. G145R was detected in one-fourth of the children with immunoprophylaxis failure. However, the pre-existence of the G145R mutant as a minor population in pregnant women does not always cause breakthrough infection in infants.

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“…Rates of vertical transmission of HCV infection range between 2%-10% [4] . Although HCV infection acquired at birth may resolve spontaneously, about 25000 to 50000 of children become chronically infected [4][5][6][7] . The prevalence of HCV infection in children is very low in Europe and the United States (0.05%-0.36%) [8] , and increases to between 1.8% and 5.8% in Egypt (which has the highest prevalence of pediatric HCV infection), Sub-Saharan Africa, Mongolia and the Amazon Basin [8] .…”

Section: Introductionmentioning

confidence: 99%

Antiviral therapy for hepatitis C: Has anything changed for pregnant/lactating women?

Spera

Eldin

Tosone

et al. 2016

WJH

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population, with the highest prevalence in individuals under 40. The prevalence in pregnant women varies with geographical distribution (highest in developing countries). Prevalence also increases in sub-populations of women at high risk for blood-transmitted infections. HCV infection in pregnancy represents a non-negligible problem. However, most of the past antiviral regimens cannot be routinely offered to pregnant or breastfeeding women because of their side effects. We briefly reviewed the issue of treatment of HCV infection in pregnant/breastfeeding women focusing on the effects of the new direct-acting antivirals on fertility, pregnancy and lactation in animal studies and on the potential risk for humans based on the pharmacokinetic properties of each drug. Currently, all new therapy regimens are contraindicated in this setting because of lack of sufficient safety information and adequate measures of contraception are still routinely recommended for female patients of childbearing potential. Core tip: Until recently, the only drugs available for the treatment of hepatitis C virus infection had a welldocumented teratogenic effect limiting their use in childbearing women. Recently, new generation drugs, designated the direct-acting antivirals have been approved. There are no studies available describing their effects on pregnant and lactating women. We here will try to analyze their pharmacokinetic properties and data from animal studies to try to predict their potential use pregnancy.Spera AM, Kamal Eldin T, Tosone G, Orlando R. Antiviral therapy for hepatitis C: Has anything changed for pregnant/ Anna Maria Spera, Tarek Kamal Eldin, Grazia Tosone, Raffaele Orlando Anna Maria Spera, Tarek Kamal Eldin, Grazia Tosone, Raffaele Orlando, Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples Federico II, 80131 Napoli, ItalyAuthor contributions: Spera AM designed and wrote the review; Kamal Eldin T analyzed pharmacological and clinical data; Tosone G and Orlando R overview the manuscript.Conflict-of-interest statement: All authors declare any conflicting interests (including but not limited to commercial, personal, political, intellectual or religious interests). In addition, reviewers have not potential conflicting interests related to any particular paper they maybe are asked to review.

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Hepatitis B and C in pregnancy: a review and recommendations for care

Cited by 89 publications

References 103 publications

Hepatitis C Seroprevalence Among HIV-Infected Childbearing Women in New York State in 2006

Hepatitis C Seroprevalence Among HIV-Infected Childbearing Women in New York State in 2006

Evaluation of the G145R Mutant of the Hepatitis B Virus as a Minor Strain in Mother-to-Child Transmission

Antiviral therapy for hepatitis C: Has anything changed for pregnant/lactating women?

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