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In women with high HBV DNA levels, the use of antenatal anti-viral medication in addition to hepatitis B vaccination and immunoglobulin (HBIG) for the neonate has been shown to further reduce the vertical transmission rate. The purpose of this study was to examine the efficacy of tenofovir prophylaxis to reduce maternal HBV DNA levels and vertical transmission in highly viremic women.
We performed a retrospective chart review of mothers positive for hepatitis B surface antigen who delivered between 2006 and 2012. We identified women with positive hepatitis Be antigen and HBV DNA levels > 6 log 10 copies/mL who were treated with tenofovir in the third trimester of pregnancy.
There were 22 women identified. The majority were of Micronesian or Asian ethnicity. All of the women had normal aspartate aminotransferase and alanine aminotransferase levels. All were negative for hepatitis C antibody and human immunodeficiency virus infection. Tenofovir was started in the third trimester with a median duration of 6 weeks. There was a reduction in mean HBV DNA levels from baseline 7.17 ± 0.90 log copies/mL to 5.8 ± 1.17 log copies/mL after treatment. Only 1 woman reported a side effect, which was nausea and vomiting. There were 5 (22.7%) preterm deliveries and 5 (22.7%) cesarean deliveries. All infants received hepatitis B vaccination and HBIG at delivery. Postnatal hepatitis B surface antigen testing at 9-12 months was available for 12 infants, all of which were negative.
This is the second published case series to date on the use of tenofovir prophylaxis in HBV mono-infected, highly viremic mothers. This series suggests the use of tenofovir in the third trimester reduces maternal HBV DNA levels, and is well-tolerated.