Prevention of mother-to-child transmission: the key of hepatitis B virus elimination

Excerpt

The final issue is to define the indication of initiating treatment of HBV in pregnant women. In a retrospective study of 2356 children, the offspring of HBeAg-positive mothers had significant higher risk for chronic HBV infection than those of HBeAg-negative mothers (9.26 vs. 0.23%, p < 0.001) [18]. A prospective study from Taiwan further demonstrated that maternal viral load was significantly associated with the risk of HBV transmission. The estimated predictive rate of MTCT at maternal viral load level of 5 log₁₀ copies/ml was 0.9%. Surprisingly, the rates of MTCT increased sharply for every log increase in maternal viral load [12]. Similarly, a recent study of 1177 mother–infant pairs also indicated that higher maternal viral loads were associated with a higher risk of MTCT [19]. In the current study, the mothers in the immune tolerant phase of CHB were excluded [13]. The characteristics of immune tolerant phase entail HBeAg positivity and very high serum HBV DNA levels, thus these females have the highest risk of MTCT. Therefore, all infants born to HBsAg-positive female should also receive immunoprophylaxis of hepatitis B vaccination with or without hepatitis B immunoglobulin after birth. Furthermore, maternal serum HBV DNA level of 5 log₁₀ copies/ml (20,000 IU/ml) may serve as an indication for prophylactic antiviral therapy to prevent MTCT, irrespective of HBeAg status (Fig. 1).

…