School of Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.
Department of Pediatrics, Cardinal Tien Hospital, New Taipei City, Taiwan.
J Viral Hepat. 2022 Feb;29(2):107-114. doi: 10.1111/jvh.13628. Epub 2021 Nov 10.
Tenofovir disoproxil fumarate (TDF) is the preferred treatment to prevent mother-to-infant transmission in highly viremic HBV-infected women. Data on hepatitis B surface antigen (HBsAg) levels in pregnant women are lacking. We aimed to investigate prepartum and postpartum HBsAg kinetics and its correlation with HBV DNA in pregnant women. HBV-infected mothers with HBV DNA ≥7.5 log IU/ml were tested for HBsAg and HBV DNA from baseline to 6 months postpartum. Of the 186 pregnant women with comparable baseline HBsAg and HBV DNA, 101 received TDF from the third trimester until 1 month postpartum. At delivery, TDF group had mildly lower HBsAg (4.32 ± 0.47 vs. 4.54 ± 0.35 log IU/ml, p = .0004) and markedly lower HBV DNA (4.26 ± 0.97 vs. 8.11 ± 0.70 log IU/ml, p < .0001) than the control group. In the TDF group, mean reduction of HBsAg and HBV DNA from baseline to delivery were 0.22 ± 0.38 and 3.96 ± 0.93 log IU/ml. HBsAg reduction had a positive correlation (r = .309; p = .0017) with HBV DNA reduction, and was predictive of HBV DNA reduction ≥3 log IU/ml (area under the receiver operating characteristic curve, 0.67; 95% confidence interval, 0.50-0.82). At 6 months postpartum, TDF and control group had comparable HBsAg and HBV DNA. In conclusion, HBsAg decreased slightly at delivery in pregnant women receiving TDF. For monitoring the effect of antiviral therapy during pregnancy, HBV DNA is a better marker than HBsAg. Our data provided valuable information regarding monitoring HBV-infected pregnant women using antiviral therapy.
富马酸替诺福韦二吡呋酯（TDF）是预防高病毒载量乙型肝炎病毒（HBV）感染妇女母婴传播的首选治疗药物。关于孕妇乙型肝炎表面抗原（HBsAg）水平的数据尚缺乏。本研究旨在探讨孕妇产前和产后 HBsAg 的动态变化及其与 HBV DNA 的相关性。HBV DNA≥7.5 log IU/ml 的 HBV 感染孕妇在基线至产后 6 个月时检测 HBsAg 和 HBV DNA。在 186 名基线 HBsAg 和 HBV DNA 相当的孕妇中，101 名孕妇在妊娠晚期至产后 1 个月时接受 TDF 治疗。分娩时，TDF 组 HBsAg 水平略低（4.32±0.47 vs. 4.54±0.35 log IU/ml，p=0.0004），HBV DNA 水平明显较低（4.26±0.97 vs. 8.11±0.70 log IU/ml，p<0.0001）。在 TDF 组，从基线到分娩时 HBsAg 和 HBV DNA 的平均下降量分别为 0.22±0.38 和 3.96±0.93 log IU/ml。HBsAg 的下降与 HBV DNA 的下降呈正相关（r=0.309；p=0.0017），并且可预测 HBV DNA 下降≥3 log IU/ml（受试者工作特征曲线下面积，0.67；95%置信区间，0.50-0.82）。产后 6 个月时，TDF 组和对照组的 HBsAg 和 HBV DNA 相当。总之，接受 TDF 治疗的孕妇在分娩时 HBsAg 略有下降。在监测妊娠期抗病毒治疗效果时，HBV DNA 是比 HBsAg 更好的标志物。我们的数据为使用抗病毒治疗监测 HBV 感染孕妇提供了有价值的信息。
