Tenofovir disoproxil fumarate therapy to prevent hepatitis B virus vertical transmission—A review of maternal and infant outcomes

Kochaksaraei, Golasa Samadi; Shaheen, Abdel‐Aziz; Seow, Cynthia H.; Barkema, Herman W.; Coffin, Carla S.

doi:10.1111/liv.15249

Cited by 10 publications

(9 citation statements)

References 111 publications

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“…In addition to the mentioned HBeAg positive and <700S/CO, HBV DNA>5Log 10 IU/ml at delivery is a predictor of postpartum hepatitis. Postpartum hepatitis can occur in chronic HBV infected people receiving AVT or NAVT (120)(121)(122)(123). The increase rate of hepatitis during pregnancy and after delivery was 14% and 16%, respectively (5).…”

Section: High Risk Factors Of Postpartum Hepatitismentioning

confidence: 99%

Postpartum hepatitis and host immunity in pregnant women with chronic HBV infection

et al. 2023

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In order to develop immune tolerant to the fetal, maternal immune system will have some modification comparing to the time before pregnancy. Immune tolerance starts and develops at the maternal placental interface. In innate immunity, decidual natural killer (dNK) cells, macrophages and dendritic cells play a key role in immue tolerance. In adaptive immunity, a moderate increase of number and immune inhibition function of regulatory T cells (Treg) are essential for immune tolerance. The trophoblast cells and immune cells expressing indoleamine 2,3-dioxygenase (IDO), the trophoblast cells expressing HLA-G, and Th1/Th2 shifting to Th2 dominant and Th17/Treg shifting to Treg domiant are in favor of maternal fetal immune tolerance. Steroids (estrogen and progesterone) and human chorionic gonadotropin (HCG) also participate in immune tolerance by inducing Treg cells or upregulating immunosuppressive cytokines. Most of the patients with chronic HBV infection are in the “HBV immune tolerance period” before pregnancy, and the liver disease is relatively stable during pregnancy. In chronic HBV infection women, after delivery, the relative immunosuppression in vivo is reversed, and Th1 is dominant in Th1/Th2 and Th17 is dominant in Th17/Treg balance. After delivery, the number of Treg decrease and NK cells increase in quantity and cytotoxicity in peripheral blood. Liver NK cells may cause liver inflammation through a non-antigen specific mechanism. After delivery, the number of CD8+ T cells will increase and HBV specific T cell response recovers from the disfunction in pregnancy. Under the background of postpartum inflammation, the rapid decrease of cortisol after delivery, and especially the enhancement of HBV specific T cell response induced by HBV DNA and cytokines, are the main reasons for postpartum hepatitis. HBeAg positive, especially HBeAg<700 S/CO, and HBV DNA>3-5Log10IU/ml are risk factors for postpartum hepatitis. Antiviral treatment in late pregnancy can reduce the incidence of mother to child transmission (MTCT) in chronic HBV infection women. Chronic HBV infection women have hepatitis both during pregnancy and more often in 12 weeks postpartum. It is generally agreed that postpartum hepatitis is mild symptoms and self-limited. Delaying drug withdrawal to 48 weeks can increase the seroconversion rate of HBeAg in delivery women with elevated alanine aminotransferase (ALT) in pregnancy.

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Section: High Risk Factors Of Postpartum Hepatitismentioning

confidence: 99%

Postpartum hepatitis and host immunity in pregnant women with chronic HBV infection

et al. 2023

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“…Multiples studies have shown that use of antivirals in the third trimester of pregnancy for those with a viral load above 200,000 IU/mL can markedly reduce the risk of vaccine failure, which may be as high as 10% in children born to highly viremic mothers even if appropriately vaccinated at birth (reviewed by [ 48 ]). A landmark study from China showed that tenofovir disoproxil fumarate (TDF) reduced the risk of perinatal transmission from those with viral loads above 200,000 IU/mL from 18% to 5% ( p = 0.007) [ 49 ].…”

Section: Case-finding Care and Antiviral Transmission Preventionmentioning

confidence: 99%

Hepatitis B and C in Pregnancy and Children: A Canadian Perspective

Mendlowitz

Feld

Biondi

2022

Viruses

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In 2016, the World Health Organization released a plan to eliminate viral hepatitis as a public health threat by 2030. For Canada to achieve the recommended decreases in HBV- and HCV-related new diagnoses and deaths, an increase in services is urgently required. Identifying those at risk of, or who have acquired HBV and HCV, remains a challenge, especially with the emergence of new priority populations such as pregnant persons and children. Importantly, prenatal, and pediatric care are times when individuals are often already engaged with the healthcare system, leading to the potential for opportunistic or co-localized care and interventions. At present, Canada may not be maximizing all available virologic tools that could lead to increases in prevention, identification, improved management, or even cure. Here, we describe the continuum of care that includes preconception, prenatal, postpartum, and pediatric stages; and identify current global and Canadian recommendations, findings, and opportunities for improvement.

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“…ULA formulations can also serve to improve patient compliance, as was observed for people living with HIV ( 17 ). Similarly, maternal-fetal transmission would be reduced by ULA formulations ( 18 ), along with transmission and reactivation for patients on immunosuppressive therapy ( 19 ).…”

Section: Introductionmentioning

confidence: 99%

An ultralong-acting tenofovir ProTide nanoformulation achieves monthslong HBV suppression

et al. 2022

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Treatment of chronic hepatitis B virus (HBV) requires lifelong daily therapy. However, suboptimal adherence to the existing daily therapy has led to the need for ultralong-acting antivirals. A lipophilic and hydrophobic ProTide was made by replacing the alanyl isopropyl ester present in tenofovir alafenamide (TAF) with a docosyl phenyl alanyl ester, now referred to as M1TFV. NM1TFV and nanoformulated TAF (NTAF) nanocrystals were formulated by high-pressure homogenization. A single intramuscular injection of NM1TFV, but not NTAF, delivered at a dose of TFV equivalents (168 milligrams per kilogram) demonstrated monthslong antiviral activities in both HBV-transgenic and human hepatocyte transplanted TK-NOG mice. The suppression of HBV DNA in blood was maintained for 3 months. Laboratory experiments on HBV-transfected HepG2.2.15 cells affirmed the animal results and the critical role of docosanol in the sustained NM1TFV antiviral responses. These results provide clear “proof of concept” toward an emerging therapeutic paradigm for the treatment and prevention of HBV infection.

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Tenofovir disoproxil fumarate therapy to prevent hepatitis B virus vertical transmission—A review of maternal and infant outcomes

Cited by 10 publications

References 111 publications

Postpartum hepatitis and host immunity in pregnant women with chronic HBV infection

Postpartum hepatitis and host immunity in pregnant women with chronic HBV infection

Hepatitis B and C in Pregnancy and Children: A Canadian Perspective

An ultralong-acting tenofovir ProTide nanoformulation achieves monthslong HBV suppression

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