Missed Opportunities for Prevention of Perinatal Transmission of Hepatitis B: A Retrospective Cohort Study

BACKGROUND: Perinatal transmission of hepatitis B virus (HBV) can occur despite postexposure prophylaxis (PEP). Recent literature suggests that antiviral treatment during pregnancy when maternal HBV DNA levels are elevated can further decrease vertical transmission. However, HBV DNA screening is not routinely performed antenatally.OBJECTIVE: To determine the rates of HBV prevalence and perinatal transmission in an antenatal cohort.METHODS: A retrospective review of public health records (December 2008 to December 2010) was performed for both mothers and newborns.RESULTS: A total of 725 mother-infant pairs were included. Of these, 574 of 715 (80%) women had antenatal hepatitis B e antigen (HBeAg) testing performed, and 127 of 574 (22%) were HBeAg positive (HBeAg+). Of babies born to hepatitis B surface antigen-positive (HBsAg+) mothers, only 573 of 725 (79%) received complete PEP. In addition, 172 of 725 (24%) infants did not receive post-PEP blood testing or were lost to follow-up. Of the 552 infants with results available, seven cases (1.3%) of mother-to-child HBV transmission were observed, six of which involved infants born to HBeAg+ women.CONCLUSIONS: Our findings suggest that routine HBeAg screening could identify a subset of mother-infant pairs among HBsAg+ pregnant women who are at higher risk for vertical HBV transmission. Determination of viral load in expectant HBeAg+ mothers may provide more precise insight into HBV transmission to their infants.

Download Full-text

The risk of hepatitis B virus infection by transfusion in Kumasi, Ghana

Blood ◽

10.1182/blood-2002-04-1084 ◽

2003 ◽

Vol 101 (6) ◽

pp. 2419-2425 ◽

Cited By ~ 102

Author(s):

Jean-Pierre Allain ◽

Daniel Candotti ◽

Kate Soldan ◽

Francis Sarkodie ◽

Bruce Phelps ◽

...

Keyword(s):

Hepatitis B Virus ◽

Hepatitis B ◽

Blood Donors ◽

Hepatitis B Surface Antigen ◽

Hbv Dna ◽

Hbv Infection ◽

Sub Saharan Africa ◽

B Virus ◽

Sub Saharan ◽

Hbv Transmission

The risk of hepatitis B virus (HBV) transmission by transfusion in sub-Saharan Africa is considered to be relatively low, and testing of blood donors is often not done or is done relatively poorly. To re-examine this attitude, we identified HBV chronically infected blood donors from a major hospital in Ghana with a range of hepatitis B surface antigen (HBsAg) assays. Test efficacy was estimated using HBV DNA as a gold standard, and the risk of HBV infection in blood recipients was estimated for different testing strategies. Particle agglutination, dipstick, and enzyme immunoassay (EIA) HBsAg screening detected 54%, 71%, and 97% of HBV infectious donors, respectively. The risk of HBV transmission to recipients less than 10 years old ranged between 1:11 and 1:326 with blood unscreened and screened by EIA, respectively. For older recipients, the risk decreased a further 4-fold because of the high frequency of natural exposure to HBV. A total of 98% of HBsAg-confirmed positive samples contained HBV DNA. HBV DNA load was less than 1 × 104 IU/mL in 75% of HBsAg-reactive samples, most of them anti-HBe reactive. Approximately 0.5% of HBsAg-negative but anti-HBc-positive samples contained HBV DNA. The use of sensitive HBsAg tests is critical to prevent transfusion transmission of HBV infection to young children in a population with a 15% prevalence of chronic HBV infection in blood donors. However, this will not have much effect on the prevalence of this infection unless other strategies to protect children from infection are also advanced in parallel.

Download Full-text

Kidney Transplantation From Hepatitis B Surface Antigen (HBsAg)–Positive Living Donors to HBsAg-Negative Recipients: Clinical Outcomes at a High-Volume Center in China

Clinical Infectious Diseases ◽

10.1093/cid/ciaa178 ◽

2020 ◽

Cited By ~ 1

Author(s):

Xian-ding Wang ◽

Jin-peng Liu ◽

Tu-run Song ◽

Zhong-li Huang ◽

Yu Fan ◽

...

Keyword(s):

Kidney Transplantation ◽

Hepatitis B ◽

Surface Antigen ◽

Hepatitis B Surface Antigen ◽

Graft Loss ◽

Graft Function ◽

Living Donors ◽

Hbv Dna ◽

Control Group ◽

Hbv Transmission

Abstract Background Data on kidney transplantation (KTx) from hepatitis B surface antigen (HBsAg)–positive (HBsAg+) donors to HBsAg-negative (HBsAg−) recipients [D(HBsAg+)/R(HBsAg-)] are limited. We aimed to report the outcomes of D(HBsAg+)/R(HBsAg−) KTx in recipients with or without hepatitis B surface antibody (HBsAb). Methods Eighty-three D(HBsAg+)/R(HBsAg−) living KTx cases were retrospectively identified. The 384 cases of KTx from hepatitis B core antibody–positive (HBcAb+) living donors to HBcAb-negative (HBcAb−) recipients [D(HBcAb+)/R(HBcAb−)] were used as the control group. The primary endpoint was posttransplant HBsAg status change from negative to postive (-− →+). Results Before KTx, 24 donors (28.9%) in the D(HBsAg+)/R(HBsAg−) group were hepatitis B virus (HBV) DNA positive, and 20 recipients were HBsAb−. All 83 D(HBsAg+)/R(HBsAg−) recipients received HBV prophylaxis, while no D(HBcAb+)/R(HBcAb−) recipients received prophylaxis. After a median follow-up of 36 months (range, 6–106) and 36 months (range, 4–107) for the D(HBsAg+)/R(HBsAg−) and D(HBcAb+)/R(HBcAb−) groups, respectively, 2 of 83 (2.41%) D(HBsAg+)/R(HBsAg−) recipients and 1 of 384 (0.26%) D(HBcAb+)/R(HBcAb−) became HBsAg+, accompanied by HBV DNA-positive (P = .083). The 3 recipients with HBsAg−→+ were exclusively HBsAb−/HBcAb− before KTx. Recipient deaths were more frequent in the D(HBsAg+)/R(HBsAg−) group (6.02% vs 1.04%, P = .011), while liver and graft function, rejection, infection, and graft loss were not significantly different. In univariate analyses, pretransplant HBsAb−/HBcAb− combination in the D(HBsAg+)/R(HBsAg−) recipients carried a significantly higher risk of HBsAg−→+, HBV DNA−→+, and death. Conclusions Living D(HBsAg+)/R(HBsAg−) KTx in HBsAb+ recipients provides excellent graft and patient survivals without HBV transmission. HBV transmission risks should be more balanced with respect to benefits of D(HBsAg+)/R(HBsAg−) KTx in HBsAb-/HBcAb− candidates.

Download Full-text

P1674KIDNEY TRANSPLANTATION FROM HBSAG+ LIVING DONORS TO HBSAG- RECIPIENTS: CLINICAL OUTCOMES AT A HIGH-VOLUME CENTER

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1674 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Xianding Wang ◽

Jinpeng Liu ◽

Tao Lin

Keyword(s):

Hepatitis B ◽

Hepatitis B Surface Antigen ◽

Graft Loss ◽

Graft Function ◽

High Volume ◽

Living Donors ◽

Hbv Dna ◽

Control Group ◽

High Volume Center ◽

Hbv Transmission

Abstract Background and Aims Data on kidney transplantation (KTx) from hepatitis B surface antigen (HBsAg)+ donors to HBsAg- recipients [D(HBsAg+)/R(HBsAg-)] are limited. We aimed to report the outcomes of D(HBsAg+)/R(HBsAg-) KTx in recipients with or without hepatitis B surface antibody (HBsAb). Method Eighty-three D(HBsAg+)/R(HBsAg-) living KTx cases were retrospectively identified. The 384 cases of KTx from hepatitis B core antibody (HBcAb)+ living donors to HBcAb- recipients [D(HBcAb+)/R(HBcAb-)] were used as the control group. Primary endpoint was post-transplant HBsAg -→+. Results Before KTx, 24 donors (28.9%) in the D(HBsAg+)/R(HBsAg-) group were hepatitis B virus (HBV) DNA+, and 20 recipients were HBsAb-. All eighty-three D(HBsAg+)/R(HBsAg-) recipients received HBV prophylaxis, while no D(HBcAb+)/R(HBcAb-) recipients received prophylaxis. After a median follow-up of 36 months (range 6-106) and 36 months (range 4-107) for the D(HBsAg+)/R(HBsAg-) and D(HBcAb+)/R(HBcAb-) groups, respectively, 2/83 (2.41%) D(HBsAg+)/R(HBsAg-) recipients and 1/384 (0.26%) D(HBcAb+)/R(HBcAb-) became HBsAg+, accompanied with HBV DNA+ (P=0.083). The three recipients with HBsAg-→+ were exclusively HBsAb-/HBcAb- before KTx. Recipient deaths were more frequent in the D(HBsAg+)/R(HBsAg-) group (6.02% vs. 1.04%, P=0.011), while liver and graft function, rejection, infection, and graft loss were not significantly different. In univariate analyses, pre-transplant HBsAb-/HBcAb- combination in the D(HBsAg+)/R(HBsAg-) recipients carried a significantly higher risk of HBsAg-→+, HBV DNA-→+, and death. Conclusion Living D(HBsAg+)/R(HBsAg-) KTx in HBsAb+ recipients provides excellent graft and patient survivals without HBV transmission. HBV transmission risks should be more balanced with respect to benefits of D(HBsAg+)/R(HBsAg-) KTx in HBsAb-/HBcAb- candidates.

Download Full-text

Efficacy and safety of stratified versus routine prophylaxis in living kidney transplantation from HBsAg+ donors to HBsAg− recipients: protocol for a multicentre, prospective, observational study

BMJ Open ◽

10.1136/bmjopen-2020-046293 ◽

2021 ◽

Vol 11 (12) ◽

pp. e046293

Author(s):

Xianding Wang ◽

Saifu Yin ◽

Turun Song ◽

Zhongli Huang ◽

Yu Fan ◽

...

Keyword(s):

Kidney Transplantation ◽

Hepatitis B ◽

Antiviral Treatment ◽

Graft Function ◽

Hbv Dna ◽

Efficacy And Safety ◽

Post Transplant ◽

Hb E ◽

Routine Prophylaxis ◽

Hbv Transmission

IntroductionIt remains unclear whether kidney transplantation (KT) from hepatitis B surface antigen (HBsAg) +donors to HBsAg− recipients (D(HBsAg+)/R(HBsAg−)) provides comparable transplant outcomes without hepatitis B virus (HBV) transmission compared with D(HBsAg−)/R(HBsAg−) KT. Moreover, no consensus has been reached for standardised prophylaxis regimens to prevent HBV transmission after D(HBsAg+)/R(HBsAg−) KT. We developed stratified prophylaxis regimens, including pretransplant antiviral treatment of donors, and pretransplant hepatitis B vaccination and post-transplant antiviral treatment of recipients, based on donors’ and recipients’ HBV serological characteristics. However, the safety and efficacy of stratified prophylaxis regimens remains unknown.Methods and analysisWe are conducting a prospective, multicentre, observational study. Between September 2020 and December 2023, 100 cases of (D(HBsAg+)/R (HBsAg−)) KT will be recruited from four university-affiliated hospitals with a follow-up at least 2 years. They will naturally receive stratified prophylaxis regimens or routine prophylaxis based on clinical experience to compare the efficacy and safety of these two regimens in (D(HBsAg+)/R(HBsAg−)) KT. The primary outcome will be post-transplant HBV infection to evaluate safety, defined as post-transplant HBsAg−→+or HBV DNA−→+. The composite endpoint of prevention failure will be also an endpoint of safety (any one of HBsAg−→+, HBV DNA−→+, HB e antigen−→+, HB e antibody−→+ and HB c antibody−→+). The efficacy will be evaluated by transplant outcomes, including death-censored graft survival, patient survival, acute rejection, delayed graft function and kidney graft function.Ethics and disseminationThis study will be registered as a clinical audit at each participating hospital and has obtained approval from the Ethics Committee of West China Hospital (reference: 2020-683, 8 September 2020).Trial registration numberNCT04562051.

Download Full-text

Thyroid dysfunction is associated with the loss of hepatitis B surface antigen in patients with chronic hepatitis B undergoing treatment with α-interferon

Journal of International Medical Research ◽

10.1177/03000605211025139 ◽

2021 ◽

Vol 49 (6) ◽

pp. 030006052110251

Author(s):

Wenfan Luo ◽

Shuai Wu ◽

Hongjie Chen ◽

Yin Wu ◽

Jie Peng

Keyword(s):

Chronic Hepatitis ◽

Hepatitis B ◽

Thyroid Function ◽

Thyroid Dysfunction ◽

Hepatitis B Surface Antigen ◽

Hbv Dna ◽

Interferon Treatment ◽

Normal Thyroid ◽

Normal Thyroid Function ◽

Hbsag Loss

Objective To investigate the influence of thyroid dysfunction on the antiviral efficacy of α-interferon in adult patients with chronic hepatitis B (CHB). Methods We performed a retrospective study of 342 patients with CHB who underwent interferon treatment for >12 weeks. Patients with thyroid dysfunction before or during treatment were defined as the thyroid dysfunction group (n = 141) and those with normal thyroid function were defined as the normal thyroid function group (n = 201). The prevalences of hepatitis B virus (HBV) DNA undetectability, low hepatitis B surface antigen (HBsAg) titre (<250 IU/mL), HBsAg loss, and hepatitis B envelope antigen loss were compared. Results During interferon treatment, 69 of 270 (25.6%) participants with normal thyroid function at baseline developed thyroid dysfunction, whereas 11 of 72 (15.3%) with thyroid dysfunction at baseline regained normal thyroid function. The thyroid dysfunction group had significantly higher prevalences of low HBsAg titre (29.8% vs. 18.9%) and HBV DNA undetectability (66.0% vs. 40.3%). Multivariate logistic regression analysis showed that thyroid dysfunction was associated with HBsAg loss (odds ratio 4.945, 95% confidence interval 1.325–18.462). Conclusions These results suggest that thyroid dysfunction is not an absolute contraindication, but is associated with HBsAg loss, in patients with CHB undergoing α-interferon treatment.

Download Full-text

Real-World Experience of Telbivudine and Lamivudine as Antiviral Prophylaxis for Chemotherapy-Related Hepatitis B Reactivation

Indonesian Journal of Cancer ◽

10.33371/ijoc.v15i1.767 ◽

2021 ◽

Vol 15 (1) ◽

pp. 11

Author(s):

Lianda Siregar ◽

Imelda Maria Loho ◽

Agus Sudiro Waspodo ◽

Siti Nadliroh ◽

Rahmanandhika Swadari ◽

...

Keyword(s):

Hepatitis B ◽

Medical Records ◽

Antiviral Treatment ◽

Hbv Dna ◽

Hbv Reactivation ◽

Lamivudine Therapy ◽

Number Of Patients ◽

Group 2 ◽

Good Treatment Option ◽

Hbs Ag

Background: There is currently no data regarding the efficacy of prophylactic telbivudine in hepatitis B patients undergoing chemotherapy. This study aims to describe the results of preemptive telbivudine and lamivudine to prevent chemotherapy-related HBV reactivation.Methods: The medical records of all patients with HBsAg positive or HBs-Ag negative, anti-HBc positive, who were referred to the hepatology clinic between May 2014 and December 2016, were retrospectively reviewed. As this is a descriptive study, no statistical analysis was done.Results: A total of 52 patients with prophylactic telbivudine or lamivudine therapy were included, with 26 patients in each group. Rituximab-based treatment was given in nine and five patients in the telbivudine and lamivudine group, respectively. The number of patients who completed antiviral treatment up to six months after chemotherapy was 17 patients in each group. There was less incidence of HBV reactivation in the telbivudine group (2 of 17 patients, 11.8%) than in the lamivudine group (7 of 17 patients, 41.2%). Delayed reactivation was noticed in 1 of 2 patients in the telbivudine group and 3 of 7 patients in the lamivudine group. The median log10[HBV DNA] at reactivation was 4.52 (1.70 – 8.35) IU/mL. Severe hepatitis was observed in two patients in the lamivudine group and one patient in the telbivudine group. Of 34 patients who completed antiviral treatment, two patients died due to primary cancer. No interruption of chemotherapy or mortality due to hepatitis was noticed in both groups.Conclusions: Preemptive telbivudine or lamivudine in HBsAg positive or HBsAg negative, anti-HBc positive patients seems to be a good treatment option.

Download Full-text

Prevention of Hepatitis B Virus Infections

PEDIATRICS ◽

10.1542/peds.75.2.362 ◽

1985 ◽

Vol 75 (2) ◽

pp. 362-364

Author(s):

Keyword(s):

Hepatitis B Virus ◽

Hepatitis B ◽

Hepatitis B Surface Antigen ◽

Far East ◽

Perinatal Transmission ◽

Perinatal Infection ◽

Virus Infections ◽

B Virus ◽

Sexual Contacts ◽

Hepatitis B Virus Infections

Infants born to mothers who are hepatitis B surface antigen (HBsAg) positive are frequently infected with hepatitis B virus (HBV). Many of these newborns will become chronic carriers of HBV and will subsequently develop chronic liver disease. Recent studies have demonstrated that perinatal transmission can be prevented by immunization of the newborn. Recommendations for the management of infants at risk are presented. PERINATAL TRANSMISSION OF HBV INFECTIONS Perinatal infection of infants by mothers who are HBsAg positive is most likely to occur if mothers are also hepatitis Be antigen positive. About 90% of infants whose mothers are positive for both markers will become infected and most will become permanent carriers.1 Infants whose mothers are HBeAg negative or who have antibody to HBeAg are at lesser risk, but can still be infected.2 Infected infants usually will not become HBsAg positive until several weeks after birth. Although clinical jaundice or acute hepatitis are rare in infected infants, elevations in transaminase levels are frequent.3 It is estimated that about one in four infants who become chronic carriers following perinatal infection will develop cirrhosis or hepatocellular carcinoma later in life. As they are persistent carriers, later in life they may transmit infection to other family members, to sexual contacts, or to others by transfusions or inoculation of their blood. Infection of female infants may eventually result in transmission of HBV to their own infants. Indeed, transmission from mother to infant is a major method of perpetuation of this virus in hyperendemic areas, eg, the Far East.

Download Full-text