Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
J Clin Virol. 2013 Apr;56(4):299-305. doi: 10.1016/j.jcv.2012.11.019. Epub 2012 Dec 28.
Women who are taking antiviral agents and become pregnant have several options that include, continuing therapy, ceasing drugs, or switching to safer drugs. However, there are limited data on the outcome in pregnant women after withdrawal of antiviral agents.
We aimed to investigate the outcome of stopping antiviral agents in pregnant women with chronic hepatitis B virus (HBV) infection.
In this single-center, retrospective cohort study, 12 pregnant patients who had received antiviral therapy for HBV and cease drugs after awareness of pregnancy between 2003 and 2010 were enrolled. We retrospectively studied virologic and biochemical flares during pregnancy and postpartum period.
Median age at pregnancy was 30.5 (range, 24-35) years, median duration of antiviral drug before pregnancy was 15.3 (range, 3.0-131.3) months, and median HBV DNA at withdrawal of therapy was 4.8 (range, 1.7-8.0) log(10) copies/mL. Eight out of twelve patients (66.7%) had a viral rebound after stopping antiviral drugs during pregnancy. Severe hepatitis flares, defined as a 5-fold increase in serum alanine aminotransferase (ALT), were observed in six patients (50%) during pregnancy. However, all of these patients spontaneously recovered without an event of hepatic decompensation. High pretreatment ALT was associated with severe hepatitis flares after cessation of therapy during pregnancy. Five patients with at least 1-year treatment before pregnancy maintained low hepatitis activity after delivery.
Pregnant women with high pretreatment ALT or those treated less than 1 year before pregnancy have high risk of severe hepatitis flares after cessation of antiviral agents.
正在服用抗病毒药物且已怀孕的女性有几种选择，包括继续治疗、停止用药或改用更安全的药物。然而，关于停药后孕妇的结局数据有限。
我们旨在研究慢性乙型肝炎病毒（HBV）感染孕妇停药后的结局。
这是一项单中心、回顾性队列研究，共纳入了 12 名于 2003 年至 2010 年期间意识到怀孕后停止接受 HBV 抗病毒治疗的孕妇。我们回顾性研究了妊娠和产后期间的病毒学和生化学反弹情况。
妊娠时的中位年龄为 30.5 岁（范围，24-35 岁），妊娠前抗病毒药物的中位使用时间为 15.3 个月（范围，3.0-131.3 个月），停药时 HBV DNA 中位数为 4.8（范围，1.7-8.0）log10 拷贝/mL。12 名患者中有 8 名（66.7%）在妊娠期间停止抗病毒药物后出现病毒反弹。6 名患者（50%）在妊娠期间出现严重肝炎发作，定义为血清丙氨酸氨基转移酶（ALT）升高 5 倍。然而，所有这些患者均自发恢复，无肝失代偿事件发生。高治疗前 ALT 与停药后妊娠期间严重肝炎发作相关。5 名在妊娠前至少接受了 1 年治疗的患者在分娩后保持低肝炎活动度。
治疗前 ALT 较高或治疗前不到 1 年的孕妇在停药后发生严重肝炎发作的风险较高。
