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HBV antivirals most commonly prescribed by gastroenterologists, hepatologists

ORLANDO, Fla. — Approximately 25% of pregnant women infected with hepatitis B received a prescription for antiviral therapy, according to research presented at the AAP National Conference & Exhibition. Gastroenterologists and hepatologists were more likely to prescribe these medications compared with physicians specializing in maternal and fetal medicine or infectious disease, researchers said.

According to Sarah Schillie, MD, MPH, MBA, a medical officer at the CDC, and colleagues, approximately 90% of infants infected with HBV in utero develop chronic disease. Currently, it is suggested that infants born to mothers infected with HBV receive vaccination and immune globulin to prevent infection. Mothers with viral loads greater than 200,000 IU/mL are recommended to also receive antiviral therapy.

Schillie told Infectious Diseases in Children that the findings revealed gaps in provider awareness of initiating treatment.

The researchers conducted a retrospective analysis of CDC data collected from Georgia, Michigan, New York City, Philadelphia and Wisconsin. All infants were born between April 2016 and December 2017.

Of the 3,971 women infected with HBV during the study period, 26.5% were prescribed antiviral therapy during pregnancy. For women who had data on HBV DNA levels (n = 1,907), 9.1% had viral loads greater than 200,000 IU/mL shortly before birth. Slightly more than one-quarter of these women were prescribed antiviral therapy.

Women were more likely to be prescribed antiviral therapy if they were aged younger than 30 years (32% vs. 23.1%), Asian/Pacific Island race (42.7% vs. 2.8% white and 6.2% black) or if their HBV was monitored by a gastroenterologist or hepatologist (55.1% vs. 10.3% maternal fetal medicine specialist or 36.4% infectious disease specialist).

Nearly all women (92.9%) were prescribed tenofovir. Very few infected women received lamivudine (3.8%).

When Schillie and colleagues examined infant outcomes, they observed an average birthweight of 3,196.7 g when they were born to mothers who were prescribed antiviral therapy. Infants born to mothers who did not receive antiviral therapy had a slightly higher average birthweight, at 3,224.7 g.

“Recommendations were provided in 2015 by the American Association of the Study of Liver Diseases, so I think it is still kind of new, and specialists need to be more aware of these recommendations,” Schillie said. “If a provider is treating a woman who is known to be HBV infected, they should go ahead and measure their viral load to guide the use of antiviral therapy for the infection.” – by Katherine Bortz

Schillie JA, et al. Antiviral therapy use for preventing perinatal hepatitis B infection. Presented at: AAP National Conference & Exhibition; Nov. 2-6, 2018; Orlando, Fla.

Disclosure: Schillie reports no relevant financial disclosures.