Sellier Pierre, Schnepf Nathalie, Amarsy Rishma, Maylin Sarah, Coutellier Martin, Lopes Amanda, Mazeron Marie-Christine, Flateau Clara, Morgand Marjolaine, Ciraru-Vigneron Nicole, Berthe Aurore, Ricbourg Aude, Dolores-Moreno Anne-Marie, Simoneau Guy, Evans John, Souak Safia, Matheron Sophie, Mouly Stephane, Benifla Jean-Louis, Simon François, Bergmann Jean-François
Internal Medicine, Hopital Lariboisière 75010, Paris, France.
Hopital Saint-Louis 75010, Virologie, Paris, France.
J Int AIDS Soc. 2014 Nov 2;17(4 Suppl 3):19632. doi: 10.7448/IAS.17.4.19632. eCollection 2014.
Human Immunodeficiency Virus (HIV) Mother-To-Child-Transmission (MTCT) and prevention by combined antiretroviral therapy (cART) have been extensively studied. Hepatitis B Virus (HBV) MTCT from HIV/HBV co-infected women and prevention by antiretroviral therapy with dual activity have been poorly studied. The aim of the study was to assess HBV MTCT from HIV/HBV co-infected women in a developed country with a large access to cART.
HIV/HBV co-infected pregnant women attending the Obstetrics Department from 1st January 2000 to 1st January 2012 could be included in the study (NCT02044068). Antiretroviral therapy during pregnancy, injection of immunoglobulin and/or vaccine to newborns was retrospectively recorded. We assessed HBV status of children at least as old as two years.
Forty nine (9.2%) from 530 HIV-infected women followed in the hospital were HIV/HBV co-infected. 34 (69.4%) had given birth to 57 children in the hospital. 13 of these women (22 children) were lost-to-follow-up, 21 women (35 children) could be studied. Twenty six children (74.3%) had HBs Ab at a protective level, 22 of them had received immunoglobulin at birth; 24 had received a complete vaccine schedule during the first six months of life (with immunoglobulin in 21 cases). The women had been given lamivudine or tenofovir/emtricitabine during eight and nine pregnancies respectively. Eight children (22.8%) were tested negative for HBs Ag, HBs Ab and HBc Ab: 4 (11.4%) had received immunoglobulin and a complete vaccine schedule; in two children, immunoglobulin was uncertain; in one child, the vaccine schedule was incomplete; in the last one, data about immunoglobulin and the vaccine schedule were lacking. The women had been given lamivudine or tenofovir/emtricitabine during five and two pregnancies respectively. One child had HBc Ab and HBs Ab, immunoglobulin was uncertain and the vaccine schedule was incomplete. The woman had been given lamivudine during the last trimester.
Three quarters of the children were protected. HBs Ab were negative in more than a tenth of the children who had received immunoglobulin and a complete vaccine schedule, questioning on long-term protection and underlining the need of control.
人类免疫缺陷病毒（HIV）母婴传播（MTCT）以及通过联合抗逆转录病毒疗法（cART）进行预防已得到广泛研究。而对于HIV/乙肝病毒（HBV）合并感染女性的HBV母婴传播以及通过具有双重活性的抗逆转录病毒疗法进行预防的研究较少。本研究的目的是评估在一个广泛可获得cART的发达国家中，HIV/HBV合并感染女性的HBV母婴传播情况。
2000年1月1日至2012年1月1日期间到产科就诊的HIV/HBV合并感染孕妇可纳入本研究（NCT02044068）。回顾性记录孕期的抗逆转录病毒治疗、给新生儿注射免疫球蛋白和/或疫苗的情况。我们评估了至少两岁儿童的HBV状况。
在医院随访的530名HIV感染女性中，有49名（9.2%）为HIV/HBV合并感染。其中34名（69.4%）在医院分娩了57名儿童。这些女性中有13名（22名儿童）失访，21名女性（35名儿童）可供研究。26名儿童（74.3%）的乙肝表面抗体（HBs Ab）处于保护水平，其中22名在出生时接受了免疫球蛋白；24名在生命的前六个月接受了完整的疫苗接种程序（21例同时接受了免疫球蛋白）。这些女性在8次和9次妊娠期间分别接受了拉米夫定或替诺福韦/恩曲他滨治疗。8名儿童（22.8%）的乙肝表面抗原（HBs Ag）、乙肝表面抗体和乙肝核心抗体（HBc Ab）检测均为阴性：4名（11.4%）接受了免疫球蛋白和完整的疫苗接种程序；2名儿童免疫球蛋白情况不明；1名儿童疫苗接种程序不完整；最后1名儿童缺乏免疫球蛋白和疫苗接种程序的数据。这些女性在5次和2次妊娠期间分别接受了拉米夫定或替诺福韦/恩曲他滨治疗。1名儿童有乙肝核心抗体和乙肝表面抗体，免疫球蛋白情况不明且疫苗接种程序不完整。该女性在妊娠晚期接受了拉米夫定治疗。
四分之三的儿童得到了保护。在接受了免疫球蛋白和完整疫苗接种程序的儿童中，超过十分之一的儿童乙肝表面抗体为阴性，这对长期保护提出了质疑，并强调了进行监测的必要性。
