Department of Obstetrics and Gynecology, Faculty of Medicine and Hasanuddin University Hospital, Hasanuddin University, Tamalanrea, Makassar, South Sulawesi, Indonesia.
Post Graduate School, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia.
J Med Virol. 2023 Jan;95(1):e28125. doi: 10.1002/jmv.28125. Epub 2022 Sep 14.
Maternal hepatitis B e Antigen (HBeAg) positivity poses a risk for hepatitis B virus (HBV) mother-to-child transmission (MTCT). In resource-constrained settings, HBeAg testing is recommended as an alternative to HBV DNA testing to establish antiviral prophylaxis eligibility. Nevertheless, the high prevalence of HBeAg-negative chronic hepatitis B (e-CHB) in many countries should not be overlooked. We studied HBV characteristics and explored the potential MTCT risk among HBeAg-negative/HBsAg-positive expectant mothers in an area prevalent of e-CHB. Among 1348 pregnant mothers screened for HBV infection, 81 (6.0%) were HBsAg-positive. These women were examined for HBeAg, HBV DNA, and cord blood HBV DNA. Sixteen (19.8%) of the HBsAg-positive mothers were HBeAg-positive, whereas 65 (80.2%) were HBeAg-negative, including eight inactive carriers (HBsAg <100 IU/ml, HBV DNA ≤ 2000 IU/ml, and ALT < 40 IU/L). Of the remaining 57 HBeAg-negative mothers, ten revealed HBV Basal Core Promoter or Precore mutations, with three having high viremia (HBV DNA > 200 000 IU/mL), which is associated with a high MTCT risk and therefore qualifies them for antiviral prophylaxis. This pilot study provides a cautionary note to the interpretation of negative HBeAg test results when determining eligibility for MTCT antiviral prophylaxis in situations with limited resources and in regions where e-CHB is prevalent.
乙型肝炎病毒表面抗原（HBsAg）阳性的母亲存在乙型肝炎病毒（HBV）母婴传播（MTCT）的风险。在资源有限的情况下，建议检测 HBeAg 来替代 HBV DNA 检测，以确定抗病毒预防的适应证。然而，许多国家 HBeAg 阴性慢性乙型肝炎（e-CHB）的高流行率不应被忽视。我们研究了 HBV 的特征，并在 e-CHB 流行的地区探索了 HBeAg 阴性/HBsAg 阳性孕妇的潜在 MTCT 风险。在筛查 HBV 感染的 1348 名孕妇中，有 81 名（6.0%）HBsAg 阳性。对这些妇女进行 HBeAg、HBV DNA 和脐带血 HBV DNA 检测。16 名（19.8%）HBsAg 阳性母亲 HBeAg 阳性，而 65 名（80.2%）HBeAg 阴性，包括 8 名非活动型携带者（HBsAg <100 IU/ml、HBV DNA ≤2000 IU/ml 和 ALT <40 IU/L）。在其余 57 名 HBeAg 阴性母亲中，有 10 名存在乙型肝炎病毒基本核心启动子或前核心区突变，其中 3 名病毒载量较高（HBV DNA >200000 IU/ml），与较高的 MTCT 风险相关，因此需要抗病毒预防。这项初步研究提醒人们，在资源有限的情况下和 e-CHB 流行的地区，在确定 MTCT 抗病毒预防适应证时，对于 HBeAg 阴性检测结果的解读应持谨慎态度。
