替诺福韦联合主被动免疫阻断高血清乙型肝炎病毒载量孕妇母婴传播效果研究*

doi:10.3969/j.issn.1672-5069.2023.02.007

Abstract

Abstract: Objective The aim of this study was to observe the blocking effect of mother-to-child transmission (MTCT) of hepatitis B virus (HBV) in pregnant women with high serum HBV loads by oral tenofovir, and human hepatitis B immunoglobulin (HBIG)and hepatitis B vaccine (HBVac) combination immunization in fetus. Methods A total of 109 pregnant women with high serum viral load of hepatitis B virus were encountered in the Fourth People's Hospital, Huai'an City, Jiangsu Province between April 2019 and February 2022, and were divided into control (n=55) and observation group (n=54). The fetus in the control group were treated with HBIG and HBVac immunization immediately after birth, and those in the observation group got the same immunization, and their mothers took tenofovir orally at gestation of 28 weeks until delivery. The mothers and fetuses were carefully followed-up for 7 months. Serum biochemical parameters, HBV markers and HBV DNA loads were routinelymonitored. The untoward pregnancy outcomes of neonates were recorded. Results At inclusion, there were no significant differences as respect to ages, gestation, pregnancy times and birth times in the two groups(P>0.05); at birth, serum HBV DNA load in the observation women was (0.8±0.8)lgIU/mL, significantly lower than [(7.8±1.1)lgIU/mL, P＜0.05] in the control, while there was no significant difference respect to serum ALT levels in the two groups [(41.5±6.4)U/L vs. (43.6±7.0)U/L, P>0.05); at the end of seven month follow-up, serum HBsAg, HBeAg and HBV DNA load in all fetuses in the observation group were negative, while they were positive in 5 cases, 4 cases and 4 cases in the control, with the blocking failure of 12.7%, much higher than 0.0% in the observation (P＜0.05). Conclusion The oral administration of tenofovir with HBIG and HBVac combination immunization could successfully block the mother-to-infant transmission of HBV, without severe untoward effects or pregnancy outcomes, which warrants further clinical investigation.

Key words: Hepatitis B virus carriers, Mother-to-child transmission, Human hepatitis B immunoglobulin, Hepatitis B vaccine, Pregnancy

Yang Xiaolei, Chi ZhenJing, Sun Yimian, et al.. Prevention of mother-to-child transmission of hepatitis B virus in pregnant women with high serum HBV loads by oral tenofovir, and human hepatitis B immunoglobulin and hepatitis B vaccine combination immunization in fetus[J]. Journal of Practical Hepatology, 2023, 26(2): 177-180.

References

[1] Li J, Hu C, Chen Y, et al. Short-term and long-term safety and efficacy of tenofovir alafenamide, tenofovir disoproxil fumarate and entecavir treatment of acute-on-chronic liver failure associated with hepatitis B. BMC Infect Dis, 2021, 21(1): 567.
[2] Li B, Liu Z, Liu X, et al. Efficacy and safety of tenofovir disoproxil fumarate and tenofovir alafenamide fumarate in preventing HBV vertical transmission of high maternal viral load. Hepatol Int, 2021, 15(5): 1103-1108.
[3] Safadi R, Khoury T, Saed N, et al. Efficacy of birth dose vaccination in preventing mother-to-child transmission of hepatitis B: a randomized controlled trial comparing engerix-B and sci-B-vac. Vaccines (Basel), 2021, 9(4): 331.
[4] 黄永群, 黄润强, 熊平安. 替诺福韦酯联合双重免疫方案阻断HBV携带孕妇母婴病毒传播效果研究. 实用肝脏病杂志, 2021, 24(3): 331-334.
[5] 江红秀, 韩国荣, 王根菊, 等. 高乙型肝炎病毒载量孕妇妊娠中晚期应用替比夫定或富马酸替诺福韦酯抗病毒治疗效果的比较. 中华传染病杂志, 2021, 39(6): 345-350.
[6] Byun K S, Choi J, Kim J H, et al. Tenofovir alafenamide for drug-resistant hepatitis B: a randomized trial for switching from tenofovir disoproxil fumarate. Clin Gastroenterol Hepatol, 2022, 20(2): 427-437.
[7] 中华医学会感染病学分会, 中华医学会肝病学分会. 慢性乙型肝炎防治指南(2019年版). 中国肝脏病杂志(电子版), 2019, 11(4): 5-27.
[8] Belopolskaya M, Avrutin V, Kalinina O, et al. Chronic hepatitis B in pregnant women: current trends and approaches. World J Gastroenterol, 2021, 27(23): 3279-3289.
[9] Zhang X, Zou H, Chen Y, et al. The effects of increased dose of hepatitis B vaccine on mother-to-child transmission and immune response for infants born to mothers with chronic hepatitis B infection: a prospective, multicenter, large-sample cohort study. BMC Med, 2021, 19(1): 148.
[10] Xu B, Xu C, Feng J, et al. Reduced mother-to-child transmission of hepatitis B after implementation of completely charge-free active-passive immunoprophylaxis: an observational cohort study. Expert Rev Vaccines, 2021, 20(7): 899-905.
[11] Chen T, Liu J, Yu Q, et al. Tenofovir plus hepatitis B immunoglobulin treatment resulted in a rapid HBV DNA load decline in high-risk pregnant women who missed the optimal time window of antiviral prophylaxis. Antivir Ther, 2019, 24(2): 125-131.
[12] Zeng Q L, Yu Z J, Ji F, et al. Tenofovir alafenamide to prevent perinatal hepatitis B transmission: a multicenter, prospective, observational study. Clin Infect Dis, 2021, 73(9): e3324-e3332.
[13] Zhu YF, Tan YF, Xu X, et al. Gamma-glutamyl transpeptidase-to-platelet ratio and the fibrosis-4 index in predicting hepatitis B virus-related hepatocellular carcinoma development in elderly chronic hepatitis B patients in China: A single-center retrospective study. Medicine (Baltimore), 2019, 98(50): e18319.
[14] Velati C, Romanò L, Pati I, et al. Prevalence, incidence and residual risk of transfusion-transmitted hepatitis B virus infection in Italy from 2009 to 2018. Blood Transfus, 2019, 17(6): 409-417.
[15] Zhang L, Yang S, Yu Y, et al. Prophylactic effect of tenofovir on viral reactivation in immunocompromised pregnant women living with hepatitis B virus. Hepatol Commun, 2022, 6(9): 2431-2440.
[16] Xu B, Liu L, Chen X. Effect of different antiviral regimens on the viral loads in pregnant women with hepatitis B virus infection and their impact on mother-to-child transmission. J Obstet Gynaecol Res, 2021, 47(6): 2110-2116.
[17] 周娟, 刘月合, 王春佟. 应用替比夫定和替诺福韦治疗阻断血清HBV DNA高载量孕妇母婴传播的效果分析. 实用肝脏病杂志, 2020, 23(6): 805-808.
[18] Rato J, Alves D, Rodrigues L. Passive transfer of hepatitis B antibodies through intravenous immunoglobulin in a neonate. Acta Med Port, 2019, 32(12): 782-784.
[19] 熊霞鹂, 魏宏, 朱云霞, 等. 富马酸替诺福韦二吡呋酯对HBV感染孕妇肾功能和胎儿生长发育的安全性研究. 实用肝脏病杂志, 2022, 25(4): 484-487.
[20] Lyu J, Wang S, He Q, et al. Hep B Moms: A cross-sectional study of mother-to-child transmission risk among pregnant Asian-American women with chronic hepatitis B in New York City, 2007-2017. J Viral Hepat, 2020, 27(2): 168-175.
[21] David G, Fogeron ML, Montserret R, et al. Phosphorylation and alternative translation on wheat germ cell-free protein synthesis of the DHBV large envelope protein. Front Mol Biosci, 2019, 6: 138.
[22] Jiragraivutidej C, Tangkijvanich P, Chaithongwongwatthana S. Use of hepatitis B-e antigen to identify pregnant women with hepatitis B virus infection who need antiviral therapy for prevention of mother-to-child transmission. Cureus, 2021, 13(10): e18430.
[23] 蒋海燕, 徐晓英, 顾桂芳. 妊娠中后期口服替诺福韦联合主被动免疫对乙型肝炎病毒母婴传播的阻断效果和安全性. 中西医结合肝病杂志, 2022, 32(6): 513-515, 519.
[24] Ma T, Lee LY, Aw MM, et al. Cost-effectiveness analysis of antiviral treatment for pregnant women with high viral load to prevent hepatitis B virus vertical transmission. Singapore Med J, 2020, 61(1): 24-27.

Prevention of mother-to-child transmission of hepatitis B virus in pregnant women with high serum HBV loads by oral tenofovir, and human hepatitis B immunoglobulin and hepatitis B vaccine combination immunization in fetus

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[2]	Yan Zhaolan, Zu Hongmei, Cai Changxia, et al. Clinical features of chronic hepatitis B viral infected individuals with low serum alanine aminotransferase levels: clues for early liver biopsies [J]. Journal of Practical Hepatology, 2022, 25(3): 343-346.
[3]	Huang Yongqun, Huang Runqiang, Xiong Ping’an. Efficacy of tenofovir disoproxil fumarate and dual immunization regimen in blocking mother-to-child hepatitis B viral transmission in pregnant women with hepatitis B virus carrier [J]. Journal of Practical Hepatology, 2021, 24(3): 331-334.
[4]	Zhu Lin, Qin Gang. Progress in diagnosis and treatment of patients with pregnancy-specific liver disease [J]. Journal of Practical Hepatology, 2021, 24(3): 449-452.
[5]	Hanbai Yila, Suo Shuyi, Wei Dongmei, et al. Efficacy and safety of tenofovir disoproxil fumarate and telbivudine on blocking mother-to-child transmission of hepatitis B virus infection [J]. Journal of Practical Hepatology, 2021, 24(2): 192-195.
[6]	Zhou Juan, Liu Yuehe, Wang Chuntong. Efficacy of telbivudine and tenofovir in blocking mother-to-infant transmission of hepatitis B virus in pregnant women with high serum HBV DNA loads [J]. Journal of Practical Hepatology, 2020, 23(6): 805-808.
[7]	Yu Jiao, Chen Jixiu, Xue Jianya, et al.. Impact ofserum cytokines on maternal-infant transmission of hepatitis B virus in HBsAg positive women [J]. Journal of Practical Hepatology, 2020, 23(5): 630-633.
[8]	Xing Xiaoyan,Huang Liangmiao, Fu Aixian,et al.. Short-term observation of yinzhihuang and adenosine methionine in treatment of patients withintrahepatic cholestasis of pregnancy [J]. Journal of Practical Hepatology, 2020, 23(5): 670-673.
[9]	Zhao Lei, Li Xiaodan, Liu Miao. Efficacy and risk analysis of lamivudine and telbivudine in blockingmother-to-child intrauterine infection of hepatitis B virus [J]. Journal of Practical Hepatology, 2020, 23(4): 496-499.
[10]	Fan Ling, Yang Jun, Ji Fengbing, et al. Efficacy of telbivudine on viral load loss and mother-to-child transmission in pregnant women with chronic hepatitis B viral carrier [J]. Journal of Practical Hepatology, 2020, 23(2): 179-182.
[11]	Zhou Xiaoxu, Zhang Huajie. Evaluation of fetal cardiac functions by velocity vector imaging in pregnant women with intrahepatic cholestasis of pregnancy [J]. Journal of Practical Hepatology, 2020, 23(1): 62-65.
[12]	Chen Huiting, Zhou Yongjian. Diagnosis and management of patients with intrahepatic cholestasis of pregnancy [J]. Journal of Practical Hepatology, 2020, 23(1): 153-155.
[13]	Ma Liying, Shen Lijuan.. Efficacy and safety of tenofovir in the treatment of pregnant women with high HBV DNA loads [J]. Journal of Practical Hepatology, 2019, 22(6): 836-839.
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