TDF, postnatal immunization prevent vertical transmission of HBV

Researchers said the most effective approach to preventing vertical transmission of hepatitis B virus was a combination of maternal use of tenofovir disoproxil fumarate, or TDF, and postnatal immunization.

Specifically, findings showed that TDF was the only antiretroviral treatment (AVT) given to women who were positive for both hepatitis B surface (HBsAg) and envelope antigens (HBeAg) that significantly reduced the risk for transmission in neonates who received the HBV vaccine and HBV immune globulin (HBIG) after birth.

“There is a paucity of randomized controlled trial (RCT) data for different regimens for the prevention of vertical transmission of HBV, and there has been a lack of granularity in pooling evidence for the most effective AVT,” Ha T. Nguyen, MSc, of Mahidol University in Bangkok, Thailand, and colleagues wrote in the American Journal of Obstetrics and Gynecology.

Nguyen and colleagues conducted a meta-analysis of 30 RCTs (n = 4,459) comparing the efficacy of various pharmacological interventions for preventing vertical transmission of HBV. They searched for studies up to Oct. 28, 2020.

In infants, a combination of HBIG and the HBV vaccine was more effective compared with the vaccine alone (RR = 0.52; 95% CI, 0.3-0.91), HBIG alone (RR = 0.26; 95% CI, 0.13-0.5) and placebo (RR = 0.16; 95% CI, 0.08-0.31).

Only maternal TDF combined with HBIG and the vaccine in infants was associated with a significantly lower risk for transmission compared with HBIG and the vaccine alone (RR = 0.1; 95% CI, 0.03-0.35). The addition of other AVTs, such as telbivudine and lamivudine, or maternal HBIG did not further reduce the risk for vertical transmission, the researchers said.

“Among [HBsAg-positive] and [HBeAg-positive] mothers, our review indicated that provision of HBIG to infants, in addition to HBV vaccine, significantly reduced the risk of vertical transmission of HBV by 48%,” the authors concluded.

Nguyen and colleagues said the results should be interpreted with caution because only a small number of RCTs evaluated the efficacy of maternal HBIG and AVT, and only a single RCT with a limited number of participants compared lamivudine with placebo. However, they mentioned that their review was “almost double in size” of that of a previous meta-analysis and included a larger number of participants.