Low-Dose Hepatitis B Immunoglobulin Given “On Demand” in Combination With Lamivudine: A Highly Cost-Effective Approach to Prevent Recurrent Hepatitis B Virus Infection in the Long-Term Follow-Up After Liver Transplantation

Paolo, D. Di; Tisone, Giuseppe; Piccolo, Paola; Lenci, Ilaria; Zazza, Settimio; Angélico, M.

doi:10.1097/01.tp.0000118904.63669.eb

Cited by 52 publications

(38 citation statements)

References 22 publications

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“…The effect of HBIG on the transcytosis of HBV was studied. We used doses of HBIG based on minimum target serum concentrations of antibody in liver transplant patients receiving HBIG: approximately 100 mg/ liter (10,21,29). HBIG treatment at both 100 mg/liter and 1,000 mg/liter reduced HBV transcytosis by a modest but significant degree compared to untreated cells and antibody-negative serum (P ϭ 0.024) (Fig.…”

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confidence: 99%

Hepatitis B Virus Translocates across a Trophoblastic Barrier

Bhat

Anderson

2007

J Virol

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Mother-infant transmission of hepatitis B virus (HBV) accounts for up to 30% of worldwide chronic infections. The mechanism and high-risk period of HBV transmission from mother to infant are unknown. Although largely prevented by neonatal vaccination, significant transmission continues to occur in high-risk populations. It is unclear whether HBV can traverse an intact epithelial barrier to infect a new host. Transplacental transmission of a number of viruses relies on transcytotic pathways across placental cells. We wished to determine whether infectious HBV can traverse a polarized trophoblast monolayer. We used a human placenta-derived cell line, BeWo, cultured on membranes as polarized monolayers, to model the maternal-fetal barrier. We assessed the effects of placental maturity and maternal immunoglobulin on viral transport. Intracellular viral trafficking pathways were investigated by confocal microscopy. Free HBV (and infectious duck hepatitis B virus) transcytosed across trophoblastic cells at a rate of 5% in 30 min. Viral transport occurred in microtubule-dependent endosomal vesicles. Additionally, confocal microscopy showed that the internalized virus traverses a monensin-sensitive endosomal compartment. Differentiation of the cytotrophoblasts to syncytiotrophoblasts resulted in a 25% reduction in viral transcytosis, suggesting that placental maturity may protect the fetus. Virus translocation was also reduced in the presence of HBV immunoglobulin. We show for the first time that transcytosis of infectious hepadnavirus can occur across a trophoblastic barrier early in gestation, with the risk of transmission being reduced by placental maturity and specific maternal antibody. This study suggests a mechanism by which mother-infant transmission may occur.

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confidence: 99%

Hepatitis B Virus Translocates across a Trophoblastic Barrier

Bhat

Anderson

2007

J Virol

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“…El protocolo más aceptado utiliza el uso de 10.000 UI endovenosa durante la fase anhepá-tica del trasplante, seguido de 10.000 UI diarias por una semana, para continuar con 10.000 UI semanales, durante el primer mes y luego 10.000 UI mensuales en forma indefinida 11 . En otros estudios se han utilizado dosis entre 10.000 y 5.000 UI endovenosa por día durante la primera semana, seguidas de 5.000 UI endovenosa tres veces a la semana en la segunda semana y luego 5.000 UI mensuales en forma indefinida 12,13 . También se ha reportado en una serie pequeña el uso de HBIg intramuscular desde la fase anhepática del trasplante (2.000 UI en ese momento, seguido de la administración de 2.000 UI diarias por siete días y posteriormente 2.000 UI mensuales en forma indefinida) logrando mantener HBsAg negativo al año de seguimiento 14 .Otros estudios más recientes utilizan entre 400 a 800 UI vía IM en forma mensual asociado a Lamivudina con resultados bastante promisorios 15 .…”

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“…Para reducirlo, algunos estudios clínicos sugieren la utilización de dosis bajas de HBIg indicada "a demanda", guiada según títulos de antiHBs, en forma única o asociada al uso de análogos de nucleós(t)idos. De esta manera se logra ahorrar recursos manteniendo la efectividad de la profilaxis en la prevención de la recidiva de la infección por VHB en el posttrasplante hepático 12 . En nuestros pacientes utilizamos en promedio 41.000 UI durante el primer mes, lo que significa una reducción de 63% de la dosis estándar de HBIg.…”

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Trasplante hepático en cirrosis por virus B: profilaxis con gammaglobulina antiHBs en dosis a "demanda"

et al. 2012

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“…Combination therapy appears to be an effective strategy for reducing HBV recurrence to 0 and 16% (Table 1) (6, 39-41, 44, 46, 51, 63), and for bringing about >90% long-term negativity for HBsAg (70,71). Further, combination therapy is more cost effective because the dosage of HBIg, which is expensive, can be reduced, making NA and HBIg combination therapy far more economically attractive and potentially more widely available (17,19,40,43,44,(72)(73)(74)(75)(76). Some stud- (Table 1) (25,39,67).…”

Section: Combination Treatment Of Nas With Hbigmentioning

confidence: 99%

Hepatitis B Immune Globulin in Liver Transplantation Prophylaxis: An Update

Dindoost

Jazayeri

Alavian³

2012

Hepat Mon

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The article is suitable for hepatologist, internists, infectious specialists and liver transplantation departments. Context:Liver transplantation is the best treatment option for end-stage liver disease following hepatitis B (HBV) infection. However, the high rate of recurrence of HBV infection following transplantation is a disadvantage of this option. Evidence Acquisition: Over the past 2 decades, the gold standard of prophylactic treatment for the prevention of HBV re-infection following liver transplantation has been the administration of low-to high-dose hepatitis B immune globulin (HBIg) along with an antiviral agent to induce passive immunity. Results: The effectiveness of HBIg in preventing the recurrence of HBV depends on the dosage, route of administration, and duration of HBIg treatment, and the viremic status at the time of transplantation. There is currently no consensus on a standardized recommendation for therapeutic options that include HBIg administration. Conclusion: This review attempts to summarize the available data on the feasibility of such options. Most recent studies support the use of long-term combination therapy of HBIg and antiviral NAs (especially new agents).

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Low-Dose Hepatitis B Immunoglobulin Given “On Demand” in Combination With Lamivudine: A Highly Cost-Effective Approach to Prevent Recurrent Hepatitis B Virus Infection in the Long-Term Follow-Up After Liver Transplantation

Abstract: Individual HBIg consumption profiles are highly variable. A low-dose (2,000 IU) on demand HBIg administration schedule is highly cost-effective and provides more than 50% savings compared with conventional high-dose monthly schedules.

Cited by 52 publications

References 22 publications

Hepatitis B Virus Translocates across a Trophoblastic Barrier

Hepatitis B Virus Translocates across a Trophoblastic Barrier

Trasplante hepático en cirrosis por virus B: profilaxis con gammaglobulina antiHBs en dosis a "demanda"

Hepatitis B Immune Globulin in Liver Transplantation Prophylaxis: An Update

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