Department of Infectious Diseases, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, China.
Department of Infectious Diseases, The First People's Hospital of Foshan, Foshan, Guangdong Province, China.
Can J Gastroenterol Hepatol. 2019 Apr 1;2019:9703907. doi: 10.1155/2019/9703907. eCollection 2019.
Research on effects of anti-hepatitis B virus (HBV) nucleoside analogs on male fertility and birth defects is limited and safety of nucleoside analogs in pregnancy is still a concern. Chronic hepatitis B (CHB) patients in Guangdong province were surveyed using a structured questionnaire. We collected data including medication type, fertility, and birth defects. Moreover, a survey of the knowledge of antiviral nucleoside analogs safety in fertility of male patients was conducted among physicians nationwide. Semen samples of 30 patients were collected. We screened 1050 HBV-positive male patients. Reasons for not receiving antivirals in 150 patients were "did not meet criteria for antiviral therapy," fertility, and financial. Furthermore, 900 participants received antivirals (85.71%, 900/1050), including 792 patients with children and 15.15% (120/792) took anti-HBV treatment when preparing for pregnancy. Based on whether they received antiviral therapy during conception or not, we divided patients into two groups. In the child-bearing age group, 88.33% (106/120) of patients received telbivudine (LDT), whereas the other group mainly received entecavir (ETV) (87.20%, 586/672). No significant difference occurred in birth defect incidence rates between both groups. Furthermore, 558 physicians completed questionnaires. Reasons that influenced drug selection were "patient's condition," "fertility demand," "financial condition," and "compliance." Telbivudine was the first-choice drug (32.80%, 183/558) while tenofovir (TDF) was the second (2.69%, 15/558). Additionally, 61.47% of physicians considered telbivudine or tenofovir as the first choice for male patients who met antiviral criteria, whereas 19% suggested delayed therapy and follow-up until childbirth. No significant changes occurred in semen volume, concentration, mobility, and percentage before and after administration of anti-HBV nucleoside analogs, which did not affect male fertility and birth defect incidence while the desire for pregnancy influenced drug selection and timing of administration. Further research on the effects of analogs on male fertility and fetal safety is required.
抗乙型肝炎病毒（HBV）核苷类似物对男性生育力和出生缺陷影响的研究有限，且核苷类似物在妊娠期间的安全性仍令人担忧。采用结构式问卷对广东省慢性乙型肝炎（CHB）患者进行调查。收集用药类型、生育情况和出生缺陷等数据。此外，对全国范围内的男性患者抗病毒核苷类似物安全性生育知识进行了调查。采集 30 例患者的精液样本。我们筛查了 1050 例 HBV 阳性男性患者。150 例未接受抗病毒治疗的原因是“不符合抗病毒治疗标准”、生育和经济原因。此外，900 名参与者接受了抗病毒治疗（85.71%，900/1050），其中 792 名有子女，15.15%（120/792）在备孕时接受了抗 HBV 治疗。根据受孕期间是否接受抗病毒治疗，我们将患者分为两组。在生育年龄组中，106 例（120/106）患者接受替比夫定（LDT）治疗，而另一组主要接受恩替卡韦（ETV）治疗（87.20%，586/672）。两组出生缺陷发生率无显著差异。此外，558 名医生完成了问卷。影响药物选择的原因有“患者病情”、“生育需求”、“经济状况”和“依从性”。替比夫定是首选药物（32.80%，183/558），其次是替诺福韦（TDF）（2.69%，15/558）。此外，61.47%的医生认为替比夫定或替诺福韦是符合抗病毒标准的男性患者的首选药物，而 19%的医生建议延迟治疗并随访至分娩。抗 HBV 核苷类似物治疗前后精液量、浓度、活力和百分比无明显变化，不影响男性生育力和出生缺陷发生率，但生育意愿影响药物选择和治疗时机。需要进一步研究类似物对男性生育力和胎儿安全性的影响。
