Department of Gastroenterology and Liver, Liverpool Hospital, Sydney, NSW, Australia.
University of New South Wales, Sydney, NSW, Australia.
Liver Int. 2018 Jul;38(7):1212-1219. doi: 10.1111/liv.13736. Epub 2018 Mar 31.
BACKGROUND & AIMS: Antipartum antiviral therapy in the setting of high viral load is recommended to prevent mother-to-child transmission of hepatitis B although recommended viral load cut-offs vary. Quantitative HBsAg has been proposed as an alternative screening strategy to identify high viral load in this setting. Guidelines suggest testing all infants for vaccine response and infection. We set out to re-examine viral load cut-offs; the predictive value of quantitative HBsAg and the need for follow-up infant testing in our cohort.
A retrospective cohort study of 469 HBsAg positive mother-baby pairs from 2 tertiary hospitals in Sydney was performed. Antiviral therapy (lamivudine or tenofovir disoproxil fumarate) was offered to women with viral load ≥6 log IU/mL (high) from 32 weeks gestation. Transmission and vaccine response was analysed according to viral load. The utility of quantitative HBsAg in identifying high viral load was examined.
Mother-to-child transmission only occurred in setting of high viral load, in 0.85% (1/117) of those who received antiviral therapy and in 8.66% (2/23) of those who chose not to. Quantitative HBsAg did not accurately identify high-risk mothers HBV DNA ≥6 log IU/mL. Successful infant vaccine response was 98.7% overall, and 99.4% when viral load was <6 log IU/mL.
Antiviral therapy initiated at 32 weeks when maternal viral load is ≥6 log IU/mL almost completely abrogates transmission. Quantitative HBsAg does not reliably predict high viral load. When maternal viral load is <6 log IU/mL, high vaccine efficacy and zero transmission suggests testing infants is of little value.
鉴于高病毒载量会增加母婴传播的风险，建议在该情况下对产妇进行抗病毒治疗，以预防乙型肝炎病毒母婴传播。尽管推荐的病毒载量截断值有所不同，但定量 HBsAg 已被提议作为替代筛查策略，用于识别该情况下的高病毒载量。指南建议对所有婴儿进行疫苗反应和感染检测。我们旨在重新检查病毒载量截断值、定量 HBsAg 的预测价值以及在我们的队列中对婴儿进行随访检测的必要性。
对来自悉尼两家三级医院的 469 对 HBsAg 阳性母婴对进行了回顾性队列研究。从 32 周妊娠开始，为病毒载量≥6 log IU/mL（高）的女性提供抗病毒治疗（拉米夫定或替诺福韦酯）。根据病毒载量分析母婴传播和疫苗反应。检查定量 HBsAg 在识别高病毒载量方面的作用。
仅在高病毒载量的情况下才会发生母婴传播，在接受抗病毒治疗的 117 例中，有 0.85%（1/117）发生传播，在选择不接受治疗的 23 例中，有 8.66%（2/23）发生传播。定量 HBsAg 无法准确识别 HBV DNA≥6 log IU/mL 的高危产妇。总的婴儿疫苗接种成功率为 98.7%，病毒载量<6 log IU/mL 时为 99.4%。
当产妇病毒载量≥6 log IU/mL 时，在 32 周开始进行抗病毒治疗几乎完全阻断了传播。定量 HBsAg 不能可靠地预测高病毒载量。当产妇病毒载量<6 log IU/mL 时，高疫苗有效性和零传播表明对婴儿进行检测的价值不大。
