Incidence of cancer in children perinatally exposed to nucleoside reverse transcriptase inhibitors

Benhammou, Valérie; Warszawski, Josiane; Bellec, Stéphanie; Doz, François; André, Nicolás; Lacour, Brigitte; Lévine, Martine; Bavoux, F; Tubiana, Roland; Mandelbrot, Laurent; Clavel, Jacqueline; Blanche, Stéphane

doi:10.1097/qad.0b013e328311d18b

Cited by 56 publications

(36 citation statements)

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“…A recently reported prospective cohort found cancer incidence in 8853 children (median age 5.4 years) exposed to $1 antiretroviral drug (5908 received Lamivudine) during pregnancy or postpartum. 78 The incidence did not differ significantly from the general population, with 10 tumors detected. Prematurity and exposure to the combination of didanosine/lamivudine remained independently associate with cancer, but the authors advised that long-term surveillance is warranted.…”

Section: Lamivudinementioning

confidence: 78%

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Chronic Hepatitis B Virus Infection and Pregnancy

Kumar

Singh

Sinha

2012

Journal of Clinical and Experimental Hepatology

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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...

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Section: Lamivudinementioning

confidence: 78%

“…Prematurity and exposure to the combination of didanosine/lamivudine remained independently associate with cancer, but the authors advised that long-term surveillance is warranted. 78 Thus of all the antivirals active against HBV, lamivudine has the most safety data in pregnancy.…”

Section: Lamivudinementioning

confidence: 99%

Chronic Hepatitis B Virus Infection and Pregnancy

Kumar

Singh

Sinha

2012

Journal of Clinical and Experimental Hepatology

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“…Diğer önemli bir konuda, oral antivirallere inutero veya postpartum dönemde maruz kalınmasının karsinojenite açısından risk taşıyıp taşımadığıdır. Benhmammou ve arkadaşlarının yaptığı, prospektif kohort çalışmasında gebelik sırasında ve postpartum dönemde oral antivirallere maruz kalmış 8853 çocuktan(ort.yaş 5,4 yıl, birden fazla antivirale maruz kalmışlar, 5908'u lamivudin'e maruz kalmış) 10'unda kanser saptanmış ve bu oranın genel popülasyonda rastlanılan orandan farklı olmadığını bildirmişlerdir [38]. APR'ye göre Lamivudin ve Tenofovir ilk trimestrda en çok kullanılan ajanlardır ve güvenli görünmektedirler.…”

Section: Maternal Faktörlerunclassified

HBV Infection in Pregnancy-Management and Definition of Risk Factors for Vertical Transmission

Bolat¹,

AKIN²,

Yürekli³

2015

Ann Clin Anal Med

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ÖzetHer gebe, ilk trimestrde HBV infeksiyonu açısından taranmalıdır. HBV aşı-sı gebeliğin her döneminde güvenlidir ve risk altındaki gebeler aşılanmalı-dır. Aktif hastalık veya siroz düşünülüyorsa, gebeliğin trimestr'inden bağım-sız olarak oral antiviral tedavi başlanmalıdır. İnaktif hastalık düşünülüyorsa, tedavi gebelik sonrasına ertelenebilir, ancak alevlenme riskine karşı gebelik süresince ve postpartum dönemde takip edilmelidir. Tüm enfekte gebelerin 2.trimestrin sonunda (26-28. haftalar) HBV DNA düzeyi tetkik edilmelidir. Bu konuda klavuzlarda fikir birliği olmamasına karşın viral yük >10⁶copy/ml üzerindeyse 3.trimestr başında (28.-30.haftalar) oral antiviral başlanmalıdır. HBV DNA <10⁶ kopya/ml olduğu koşullarda, önceki çocukta immünoproflak-si başarısızlığı ve HBeAg (+)'liği durumunda oral antiviral tedavi başlanmalı-dır. Oral antiviral ajan, aktif hastalık veya siroz yoksa doğumdan 4 hafta sonra kesilebilir. İleri evre hastalık varsa tedavi devamı, alevlenme ve dekompansasyon riski olduğundan önerilir. Emzirme sırasında oral antiviral tedavi öne-rilmemektedir. Bebeğe doğumda aktif-pasif immünoproflaksi uygulanmalıdır. Anahtar KelimelerGebelik; Hepatit B Virusu; Tedavi Abstract Every pregnant should be screened for HBV during first trimester.HBV vaccine is safe during pregnancy.In case of active infection or cirrhosis antiviral therapy should be started in any trimester.If HBV infection is not active treatment can be postponed until after delivery but the patient should be followed closely for HBV flares during pregnancy and postpartum period.HBV DNA levels should be measured at the end of second trimester.If viral load is >10⁶copy/ml oral antiviral should be started although there is no consensus in guidelines.If HBV DNA <10⁶ copy/ml oral antiviral treatment should be started in case of immunoprophylaxis failure in previous births or HBeAg positivity.Treatment can be stopped 4 weeks after birth if there is no active replication or cirrhosis.In case of advanced disease treatment is continued due to risk of flare or decompansation.Oral antiviral treatment is not adviced during breastfeeding.Active-passive immunoprophylaxis should be given to newborn soon after birth.

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“…Une première évaluation du risque de cancer dans la cohorte française a été réalisée en 2007. Les enfants exposés ne montraient pas de sur-risque de cancer, mais la durée moyenne d'observation était encore très limitée [35]. L'évaluation d'une éven-tuelle oncogenèse doit être impérativement poursuivie en lien avec le registre des cancers de l'enfant.…”

Section: Référencesunclassified