Tenofovir alafenamide or tenofovir disoproxil fumarate in pregnancy to prevent HBV transmission: Maternal ALT trajectory and infant outcomes

被引：1

作者：

Chen, Huey-Ling ^{[3
,4
,5
,6
]}

Lee, Chien-Nan ^{[7
]}

Chang, Chin-Hao ^{[8
]}

Lai, Ming-Wei ^{[9
,10
]}

Tsai, Ming-Chieh ^{[11
]}

Mu, Shu-Chi ^{[12
]}

Liu, Chun-Jen ^{[6
,13
,14
]}

Shih, Jin-Chung ^{[7
]}

Wen, Wan-Hsin ^{[15
,16
]}

Hu, Rui-Ting ^{[17
]}

Huang, Chun-Pin ^{[18
]}

Hu, Kuang-Chun ^{[19
]}

Chen, Chie-Pein ^{[20
]}

Lee, Chyi-Long ^{[21
]}

Chien, Rong-Nan ^{[10
]}

Chang, Kai-Chi ^{[3
,4
]}

Hsu, Hong-Yuan ^{[3
,4
,5
]}

Lee, Chien-Chang ^{[22
,23
]}

Ni, Yen-Hsuan ^{[3
,4
,6
]}

Chang, Mei-Hwei ^{[1
,2
,3
,4
,6
]}

机构：

[1] Natl Taiwan Univ, Coll Med, Dept Pediat, 17F,8,Chung Shan South Rd, Taipei 100, Taiwan

[2] Childrens Hosp, 17F,8,Chung Shan South Rd, Taipei 100, Taiwan

[3] Natl Taiwan Univ, Coll Med, Dept Pediat, Taipei, Taiwan

[4] Childrens Hosp, Taipei, Taiwan

[5] Natl Taiwan Univ, Dept & Grad Inst Med Educ & Bioeth, Coll Med, Taipei, Taiwan

[6] Natl Taiwan Univ Hosp, Hepatitis Res Ctr, Taipei, Taiwan

[7] Natl Taiwan Univ, Coll Med & Hosp, Dept Obstet & Gynecol, Taipei, Taiwan

[8] Natl Taiwan Univ Hosp, Dept Med Res, Taipei, Taiwan

[9] Linkou Chang Gung Mem Hosp, Dept Pediat, Div Pediat Gastroenterol, Taoyuan, Taiwan

[10] Linkou Chang Gung Mem Hosp, Liver Res Ctr, Taoyuan, Taiwan

[11] Hsinchu Cathay Gen Hosp, Dept Internal Med, Hsinchu, Taiwan

[12] Shin Kong Wu Ho Su Mem Hosp, Dept Pediat, Taipei, Taiwan

[13] Natl Taiwan Univ, Coll Med & Hosp, Internal Med, Taipei, Taiwan

[14] Natl Taiwan Univ, Grad Inst Clin Med, Coll Med, Taipei, Taiwan

[15] Cardinal Tien Hosp, Dept Pediat, New Taipei, Taiwan

[16] Fu Jen Catholic Univ, Coll Med, Sch Med, New Taipei, Taiwan

[17] Cathay Gen Hosp, Dept Internal Med, Taipei, Taiwan

[18] Hsinchu Cathay Gen Hosp, Dept Pediat, Hsinchu, Taiwan

[19] MacKay Mem Hosp, Dept Internal Med, Taipei, Taiwan

[20] MacKay Mem Hosp, Dept Obstet & Gynecol, Taipei, Taiwan

[21] Linkou Chang Gung Mem Hosp, Dept Obstet & Gynecol, Taoyuan, Taiwan

[22] Natl Taiwan Univ Hosp, Dept Emergency Med, Taipei, Taiwan

[23] Natl Taiwan Univ Hosp, Ctr Intelligent Healthcare, Taipei, Taiwan

来源：

LIVER INTERNATIONAL | 2024年 / 44卷 / 06期

关键词：

antiviral therapy; children; HBeAg; HBV immunization; hepatitis B virus; mother-to-infant transmission; nucleoside analogue; pregnancy; pregnant women; HEPATITIS-B-VIRUS; PERINATAL TRANSMISSION; MASS VACCINATION; INFECTION; CHILDREN; MOTHERS; WOMEN; STRATEGIES; MANAGEMENT; EFFICACY;

D O I：

10.1111/liv.15873

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

Background: The use of antiviral agents, specifically tenofovir disoproxil fumarate (TDF), in pregnant women to prevent mother-to-child HBV transmission is a key step towards hepatitis elimination. However, data on using tenofovir alafenamide (TAF) is insufficient. The frequent occurrence of postpartum ALT flares may impact the clinical implementation. Methods: The maternal and infant outcomes were compared in multi-centre trials of high viral load HBsAg/HBeAg+ pregnant women receiving TAF or TDF from the third trimester until 2 weeks postpartum with intensive follow-ups. To explore the dynamic pre- and postpartum changes in ALT levels, we used a group-based trajectory model for analysing data of 332 women from three prospective studies. Results: After treatment, the maternal HBV DNA levels significantly decreased from baseline to delivery: 7.87 +/- 0.59 to 3.99 +/- 1.07 Log(10) IU/mL TAF (n = 78) and 8.30 +/- 0.36 to 4.47 +/- 0.86 Log(10) IU/mL (TDF, n = 53), with viral load reductions of 3.87 versus 3.83 Log(10) IU/mL. The HBsAg-positive rates among 12-month-old infants were 1.28% (1/78) versus 1.82% (1/55) respectively (p = 1.00). Of the TAF or TDF-treated mothers, 25.64% versus 16.98% experienced ALT > 2X ULN, and 11.54% versus 1.89% received extended antiviral treatment. Our model revealed four distinct ALT patterns: stable ALT (87.2%), moderate (8.0%) or marked (2.4%) postpartum flares, or prepartum elevations (2.4%). Conclusions: TAF effectively reduces mother-to-child HBV transmission, but prophylaxis failure still occurred in few cases. Postpartum ALT flares are common in women receiving TAF or TDF during pregnancy. Approximately 12.8% of mothers may require extended postpartum antiviral treatment.

引用

页码：1422 / 1434

页数：13

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