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Alloveda Liver Update: Safety of Antiviral Therapy and Drug Withdrawal to Prevent Mother-To-Child Transmission of HBV during Pregnancy

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eMediNexus    12 July 2020

Prenatal antiviral therapy (AVT) is known to prevent vertical transmission of hepatitis B virus (HBV). The evidence is scarce; however, on the safety of postpartum cessation of AVT, which may induce alanine aminotransferase (ALT) elevation. A study published in the Journal of Medical Virology explored the necessity of prolonging maternal AVT after delivery.

Mothers with chronic hepatitis B, at the immune-tolerant phase, with HBV DNA levels > 6 log10 IU/ml were included in the study and were administered AVT during the third trimester until delivery. Patients could discontinue AVT either at delivery or postpartum week (PPW) 6. Mothers who deferred AVT during pregnancy formed the control group. All mothers were followed until postpartum week 52 and clinical and virological parameters of hepatitis flares were assessed.

Of the 118 mothers in the study, 91 received AVT; 53 (group A) and 24 (group B) discontinued their treatment at delivery and postpartum week 6, respectively. In all, 27 mothers deferred AVT during pregnancy [control group (group C)]. One hundred four of the 118 mothers completed the study. About 50% of them (52/104) had postpartum elevated ALT levels, which were mild and moderate. Six of the 104 (5.77%) had levels > 5 times the upper limit of normal. Nearly 70% (36/52) of the ALT elevations were noted within 12 weeks after delivery. Subgroup analyses revealed that the frequency of ALT rise was similar among the groups [A: 50.9% (27/53) vs. B: 58.3% (14/24) vs C: 40.7% (11/27); P = 0.447]. The mean peak ALT level in the three groups was 108.4, 74.1, and 126.7 U/L in groups A/B/C, respectively (P = 0.291).

Postpartum ALT flares were commonly seen among mothers with or without AVT during pregnancy; however, most cases of ALT elevation were mild to moderate. Extending AVT to postpartum week 6 was not shown to have an impact on maternal outcomes. The study observed that AVT should be discontinued at birth.

Source: Xiao L-X, Chen Y-R, Huang P, et al. The Safety of Antiviral Therapy and Drug Withdrawal for the Prevention of Mother-To-Child Transmission of HBV During Pregnancy. J Med Virol. 2020 May 15.

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