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Antiviral therapy reduces mother-to-child transmission of HBV

In a systematic review, using antiviral therapy among pregnant mothers with hepatitis B virus infection was found to reduce mother-to-child transmission compared with no treatment and infants receiving vaccination at birth alone, according to published findings.

Researchers, including Robert S. Brown Jr., MD, MPH, division of gastroenterology and hepatology, Weill Cornell Medical College, collected and analyzed data from 26 controlled studies found in multiple databases that enrolled pregnant women with chronic HBV and underwent treatment with antiviral therapy.

Robert S. Brown Jr.

The goal of the review and meta-analysis was to determine any reduction of mother-to-child transmission of HBV and adverse outcomes to mothers and newborns. A total of 3,622 pregnant women were in the studies. All infants received HBV vaccination at birth.

Overall, antiviral therapy reduced mother-to-child transmission through seropositivity of infant hepatitis B surface antigen (HBsAg; RR = 0.3; 95% CI, 0.2-0.4) or seropositivity of infant HBV DNA (RR = 0.3; 95% CI, 0.2-0.5) between 6 and 12 months of age.

Treatment with Epivir (lamivudine, ViiV Healthcare) or Tyzeka (telbivudine, Novartis) improved maternal HBV DNA suppression at delivery and during postpartum follow-up. In addition, treatment with Viread (tenofovir, Gilead Sciences) showed improvement in HBV DNA suppression at delivery.

“The use of telbivudine, lamivudine and tenofovir appears to be safe in pregnancy with no increased adverse maternal or fetal outcome,” the researchers wrote.

When comparing any antiviral treatment to controls for any evidence of fetal harms, there were no significant differences in the congenital malformation rate, prematurity rate and Apgar scores. In addition, no significant differences were observed in postpartum hemorrhage, cesarean section and elevated creatinine kinase rates.

The researchers noted that while these three antiviral drugs are licensed for the treatment of chronic HBV and HIV, they are not approved for use in pregnancy. The researchers recommend the use of these drugs in women who have HBV DNA levels greater than 200,000 IU/mL or who are positive for hepatitis B e antigen in their third trimester, to prevent transmission to the infant.

The researchers concluded: “Antiviral therapy improves HBV suppression and reduces [mother-to-child transmission] in women with chronic HBV infection with high viral load compared to the use of hepatitis B immunoglobulin and vaccination alone.” – by Melinda Stevens

Disclosure: Brown Jr. reports consulting for Bristol-Myers Squibb and Gilead Sciences. Please see the full study for a list of all other authors’ relevant financial disclosures.