Optimal timing of hepatitis B virus DNA quantification and clinical predictors for higher viral load during pregnancy

Abstract

Introduction Authorities publish recommendations on the hepatitis B virus (HBV) viral load threshold to initiate antiviral treatment but the timing of quantification during pregnancy is not well defined. HBV DNA levels in pregnancy women at 28‐30 weeks predict the risk of immunoprophylaxis failure. This study compared and evaluated the correlation between HBV DNA levels before 22 and 28‐30 weeks’ gestation. Clinical predictive factors for HBV DNA >6, 7 and 8 log10 IU/mL were studied. Material and methods A retrospective analysis of HBV DNA levels of women <22 and 28‐30 weeks of gestation was carried out in 352 pregnant HBV carriers. HBV DNA was examined using the COBAS TaqMan HBV Monitor Test coupled with the COBAS Ampliprep extraction system (Both Roche Diagnostics, Branchburg, NJ, USA). Results A strong positive correlation was found between the viral loads of women <22 weeks (mean 16.7 weeks) and 28‐30 weeks of gestation, which was independent of the viral load level and gestational age of quantification (r = 0.942, P < 0.001). Univariate analysis showed that positive hepatitis B e antigen (HBeAg), maternal age <35 years old and body mass index ≤21 kg/m2 were associated with a higher mean viral load at 28‐30 weeks of gestation (P < 0.05). These factors were also associated with a higher chance of viral load >6, 7 and 8 log10 IU/mL at 28‐30 weeks (P < 0.05). In multiple regression analysis, only the viral load of <22 weeks and positive HBeAg remained predictive of a higher mean viral load at 28‐30 weeks of gestation (P < 0.05). The receiver operating characteristic curve showed that the HBV DNA of <22 weeks was an excellent predictor for different viral load cut‐offs at 28‐30 weeks. The area under curve was 0.986, 0.998 and 0.994 for viral load 6, 7 and 8 log10 IU/mL, respectively. Conclusions HBV DNA quantification should be performed before 22 weeks of gestation. Viral load cut‐offs similar to those at 28 weeks can be used to determine immunoprophylaxis failure at earlier gestation. Maternal positive HBeAg status was associated with a higher chance of viral load >6, 7 or 8 log10 IU/mL.

Acceptance of antiviral treatment and enhanced service model for pregnant patients carrying hepatitis B

“…Positive HBeAg screening results, maternal age <35 years, and body mass index ≤21 kg/m 2 have been associated with a higher mean viral load. 15 Our study showed that 22.6% of women had viral loads of ≥200 000 IU/mL, which was comparable to previous findings. Although age was not a statistically significant factor in the present study, a previous study showed that women with high viral loads were younger than women with low viral loads.…”

Immunoprophylaxis failure and vaccine response in infants born to mothers with chronic hepatitis B infection in Djibouti

“…These factors have been identified as reliable markers of active HBV replication and were the only factors associated with immunoprophylaxis failure in our study. Several recent meta-analyses have reported a high incidence of MTCT associated with high HBV DNA levels above 200000 IU/mL and HBeAg-positive status despite a vaccination series associated with HBIG[ 28 , 29 ]. These findings highlight potential targets for improving prevention strategies.…”

Prevention of maternal-to-child transmission of hepatitis B: a narrative review

“…For women with positive HBsAg, liver function and HBV DNA should be assessed. HBV DNA quantification as early as before 22 weeks of gestation can be used reliably to predict the risk of IF and guide the use of antiviral treatment 29 . Women with high HBV DNA (>200 000 IU/mL) should be seen by a hepatologist to discuss the use of TDF after 28 weeks of gestation; whereas women with low HBV DNA should also be reminded to continue with long-term follow-up for surveillance of HBV complications (Figure ).…”