中文English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 40 Issue 11
Nov.  2024
Turn off MathJax
Article Contents

New advances in antiviral therapy during pregnancy to block mother-to-child transmission of hepatitis B virus

DOI: 10.12449/JCH241105
Research funding:

“13th Five-year" National Science and Technology Major Project for Infectious of China” (2017ZX10201201-001-002);

“13th Five-year" National Science and Technology Major Project for Infectious of China” (2017ZX10201201-002-001);

Medical Innovation Team Project of Jiangsu Province (CXTDA2017040)

More Information
  • Corresponding author: HAN Guorong, hgr518@163.com (ORCID: 0000-0002-1397-8185)
  • Received Date: 2024-09-02
  • Accepted Date: 2024-10-01
  • Published Date: 2024-11-25
  • Mother-to-child transmission of hepatitis B virus (HBV) is one of the primary causes of the high disease burden of chronic hepatitis B in China, and blocking this route of transmission has an important strategic significance for eliminating hepatitis B. While immediate combined immunoprophylaxis for neonates upon birth is the fundamental strategy to block the mother-to-child transmission of HBV, there is still a mother-to-child transmission rate of 9% in mothers with high viral loads. In recent years, breakthroughs have been made in the research on antiviral therapy during pregnancy for blocking mother-to-child transmission, which marks a pivotal milestone in eliminating the mother-to-child transmission of hepatitis B. Comprehensive prophylaxis of antiviral therapy during pregnancy and immunoprophylaxis for infants after birth has become the key strategy for eliminating the mother-to-child transmission of hepatitis B. This article summarizes the development and latest advances in antiviral therapy during pregnancy for blocking mother-to-child transmission, as well as related intervention strategies and indications, in order to provide a reference for clinicians and public health physicians.

     

  • loading
  • [1]
    World Health Organization. Implementing the global health sector strategies on HIV, viral hepatitis and sexually transmitted infections, 2022-2030[R]. Geneva: WHO, 2024.
    [2]
    DIONNE-ODOM J, COZZI GD, FRANCO RA, et al. Treatment and prevention of viral hepatitis in pregnancy[J]. Am J Obstet Gynecol, 2022, 226( 3): 335- 346. DOI: 10.1016/j.ajog.2021.09.002.
    [3]
    Chinese Society of Infectious Diseases, Chinese Medical Association, Chinese Society of Hepatology, Chinese Medical Association. Guidelines for the prevention and treatment of chronic hepatitis B(version 2022)[J]. Chin J Clin Infect Dis, 2022, 15( 6): 401- 427. DOI: 10.3760/cma.j.issn.1674-2397.2022.06.001.

    中华医学会肝病学分会, 中华医学会感染病学分会. 慢性乙型肝炎防治指南(2022年版)[J]. 中华临床感染病杂志, 2022, 15( 6): 401- 427. DOI: 10.3760/cma.j.issn.1674-2397.2022.06.001.
    [4]
    World Health Organization. Hepatitis B[EB/OL].( 2024-04-09)[ 2024-07-17]. https://www.who.int/news-room/fact-sheets/detail/hepatitis-b. https://www.who.int/news-room/fact-sheets/detail/hepatitis-b
    [5]
    Infectious Disease Physicians Branch of Chinese Medical Doctor Association, National Clinical Research Center for Infectious Diseases. Expert consensus on whole-population management of hepatitis B virus infection(2023)[J]. Chin J Clin Infect Dis, 2024, 17( 1): 1- 13. DOI: 10.3760/cma.j.issn.1674-2397.2024.01.001.

    中国医师协会感染科医师分会, 国家感染性疾病临床医学研究中心. 乙型肝炎全人群管理专家共识(2023)[J]. 中华临床感染病杂志, 2024, 17( 1): 1- 13. DOI: 10.3760/cma.j.issn.1674-2397.2024.01.001.
    [6]
    BELOPOLSKAYA M, AVRUTIN V, KALININA O, et al. Chronic hepatitis B in pregnant women: Current trends and approaches[J]. World J Gastroenterol, 2021, 27( 23): 3279- 3289. DOI: 10.3748/wjg.v27.i23.3279.
    [7]
    JING WZ, LIU J, LIU M. Eliminating mother-to-child transmission of HBV: Progress and challenges in China[J]. Front Med, 2020, 14( 1): 21- 29. DOI: 10.1007/s11684-020-0744-2.
    [8]
    WEN WH, CHANG MH, ZHAO LL, et al. Mother-to-infant transmission of hepatitis B virus infection: Significance of maternal viral load and strategies for intervention[J]. J Hepatol, 2013, 59( 1): 24- 30. DOI: 10.1016/j.jhep.2013.02.015.
    [9]
    BOUCHERON P, LU Y, YOSHIDA K, et al. Accuracy of HBeAg to identify pregnant women at risk of transmitting hepatitis B virus to their neonates: A systematic review and meta-analysis[J]. Lancet Infect Dis, 2021, 21( 1): 85- 96. DOI: 10.1016/S1473-3099(20)30593-4.
    [10]
    SEGERAL O, DIM B, DURIER C, et al. Hepatitis B e antigen(HBeAg) rapid test and alanine aminotransferase level-based algorithm to identify pregnant women at risk of HBV mother-to-child transmission: The ANRS 12345 TA PROHM study[J]. Clin Infect Dis, 2020, 71( 10): e587- e593. DOI: 10.1093/cid/ciaa282.
    [11]
    HAN GR, CAO MK, ZHAO W, et al. A prospective and open-label study for the efficacy and safety of telbivudine in pregnancy for the prevention of perinatal transmission of hepatitis B virus infection[J]. J Hepatol, 2011, 55( 6): 1215- 1221. DOI: 10.1016/j.jhep.2011.02.032.
    [12]
    European Association for the Study of the Liver. EASL clinical practice guidelines: management of chronic hepatitis B virus infection[J]. J Hepatol, 2012, 57( 1): 167- 185. DOI: 10.1016/j.jhep.2012.02.010.
    [13]
    LIAW YF, KAO JH, PIRATVISUTH T, et al. Asian-pacific consensus statement on the management of chronic hepatitis B: a 2012 update[J]. J Hepatol, 2012, 6( 3): 531- 561. DOI: 10.1007/s12072-012-9365-4.
    [14]
    Chinese Society of Hepatology and Chinese Society of Infectious Diseases, Chinese Medical Association. The guideline of prevention and treatment for chronic hepatitis B: a 2015 update[J]. J Clin Hepatol, 2015, 31( 12): 1941- 1960. DOI: 10.3969/j.issn.1001-5256.2015.12.002.

    中华医学会肝病学分会, 中华医学会感染病学分会. 慢性乙型肝炎防治指南(2015年更新版)[J]. 临床肝胆病杂志, 2015, 31( 12): 1941- 1960. DOI: 10.3969/j.issn.1001-5256.2015.12.002.
    [15]
    TERRAULT NA, BZOWEJ NH, CHANG KM, et al. AASLD guidelines for treatment of chronic hepatitis B[J]. Hepatology, 2016, 63( 1): 261- 283. DOI: 10.1002/hep.28156.
    [16]
    SARIN SK, KUMAR M, LAU GK, et al. Asian-Pacific clinical practice guidelines on the management of hepatitis B: A 2015 update[J]. Hepatol Int, 2016, 10( 1): 1- 98. DOI: 10.1007/s12072-015-9675-4.
    [17]
    PAN CQ, DUAN ZP, DAI EH, et al. Tenofovir to prevent hepatitis B transmission in mothers with high viral load[J]. N Engl J Med, 2016, 374( 24): 2324- 2334. DOI: 10.1056/NEJMoa1508660.
    [18]
    PAN CQ, DAI EH, DUAN ZP, et al. Long-term safety of infants from mothers with chronic hepatitis B treated with tenofovir disoproxil in China[J]. Gut, 2022, 71( 4): 798- 806. DOI: 10.1136/gutjnl-2020-322719.
    [19]
    KUMAR M, ABBAS Z, AZAMI M, et al. Asian Pacific association for the study of liver(APASL) guidelines: Hepatitis B virus in pregnancy[J]. Hepatol Int, 2022, 16( 2): 211- 253. DOI: 10.1007/s12072-021-10285-5.
    [20]
    European Association for the Study of the Liver. EASL 2017 clinical practice guidelines on the management of hepatitis B virus infection[J]. J Hepatol, 2017, 67( 2): 370- 398. DOI: 10.1016/j.jhep.2017.03.021.
    [21]
    European Association for the Study of the Liver. EASL clinical practice guidelines on the management of liver diseases in pregnancy[J]. J Hepatol, 2023, 79( 3): 768- 828. DOI: 10.1016/j.jhep.2023.03.006.
    [22]
    TERRAULT NA, LOK ASF, MCMAHON BJ, et al. Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance[J]. Hepatology, 2018, 67( 4): 1560- 1599. DOI: 10.1002/hep.29800.
    [23]
    YANG N, ZHOU GL, CHENG XL, et al. Distribution evaluation of tenofovir in the breast milk of mothers with HBeAg-positive chronic HBV infection after treatment with tenofovir alafenamide and tenofovir disoproxil fumarate by a sensitive UPLC-MS/MS method[J]. Front Pharmacol, 2021, 12: 734760. DOI: 10.3389/fphar.2021.734760.
    [24]
    CHAN HLY, BUTI M, LIM YS, et al. Long-term treatment with tenofovir alafenamide for chronic hepatitis B results in high rates of viral suppression and favorable renal and bone safety[J]. Am J Gastroenterol, 2024, 119( 3): 486- 496. DOI: 10.14309/ajg.0000000000002468.
    [25]
    OGAWA E, JUN DW, TOYODA H, et al. Increased spine bone density in patients with chronic hepatitis B switched to tenofovir alafenamide: A prospective, multinational study[J]. Aliment Pharmacol Ther, 2024, 59( 2): 239- 248. DOI: 10.1111/apt.17785.
    [26]
    BUTI M, GANE E, SETO WK, et al. Tenofovir alafenamide versus tenofovir disoproxil fumarate for the treatment of patients with HBeAg-negative chronic hepatitis B virus infection: A randomised, double-blind, phase 3, non-inferiority trial[J]. Lancet Gastroenterol Hepatol, 2016, 1( 3): 196- 206. DOI: 10.1016/S2468-1253(16)30107-8.
    [27]
    PAN CQ, ZHU L, YU AS, et al. Tenofovir alafenamide versus tenofovir disoproxil fumarate for preventing vertical transmission in chronic hepatitis B mothers: A systematic review and meta-analysis[J]. Clin Infect Dis, 2024: ciae288. DOI: 10.1093/cid/ciae288.
    [28]
    ZENG QL, ZHANG HX, ZHANG JY, et al. Tenofovir alafenamide for pregnant Chinese women with active chronic hepatitis B: A multicenter prospective study[J]. Clin Gastroenterol Hepatol, 2022, 20( 12): 2826- 2837. e 9. DOI: 10.1016/j.cgh.2021.12.012.
    [29]
    CHAN HLY, FUNG S, SETO WK, et al. Tenofovir alafenamide versus tenofovir disoproxil fumarate for the treatment of HBeAg-positive chronic hepatitis B virus infection: A randomised, double-blind, phase 3, non-inferiority trial[J]. Lancet Gastroenterol Hepatol, 2016, 1( 3): 185- 195. DOI: 10.1016/S2468-1253(16)30024-3.
    [30]
    Infectious Diseases Physicians Branch, Chinese Medical Doctor Association; Chinese Society of Infectious Diseases, Chinese Medical Association. Chinese practice guideline for the prevention and treatment of mother-to-child transmission of hepatitis B virus(version 2024)[J]. J Clin Hepatol, 2024, 40( 8): 1557- 1566. DOI: 10.12449/JCH240809.

    中国医师协会感染科医师分会, 中华医学会感染病学分会. 中国乙型肝炎病毒母婴传播防治指南(2024年版)[J]. 临床肝胆病杂志, 2024, 40( 8): 1557- 1566. DOI: 10.12449/JCH240809.
    [31]
    YIN XR, WANG W, CHEN H, et al. Real-world implementation of a multilevel interventions program to prevent mother-to-child transmission of HBV in China[J]. Nat Med, 2024, 30: 455- 462. DOI: 10.1038/s41591-023-02782-x.
    [32]
    Chinese Society of Infectious Diseases, Chinese Medical Association, Chinese Society of Hepatology, Chinese Medical Association. Guidelines for the prevention and treatment of chronic hepatitis B(version 2019)[J]. J Clin Hepatol, 2019, 35( 12): 2648- 2669. DOI: 10.3969/j.issn.1001-5256.2019.12.007.

    中华医学会感染病学分会, 中华医学会肝病学分会. 慢性乙型肝炎防治指南(2019年版)[J]. 临床肝胆病杂志, 2019, 35( 12): 2648- 2669. DOI: 10.3969/j.issn.1001-5256.2019.12.007.
    [33]
    LIU N. Comparative analysis of pregnancy complications and perinatal complications between second and first pregnant women[J]. J Shanxi Health Vocat Coll, 2022, 32( 1): 16- 17.

    刘娜. 二胎与首胎孕妇妊娠期合并症和围生期并发症比较分析[J]. 山西卫生健康职业学院学报, 2022, 32( 1): 16- 17.
    [34]
    FENG FL. Correlation of maternal age with pregnancy risk factors and pregnancy outcome[J]. China Pract Med, 2023, 18( 7): 48- 51. DOI: 10.14163/j.cnki.11-5547/r.2023.07.011.

    冯富丽. 孕妇年龄与妊娠高危因素及妊娠结局的关系[J]. 中国实用医药, 2023, 18( 7): 48- 51. DOI: 10.14163/j.cnki.11-5547/r.2023.07.011.
    [35]
    LIU F, YAN Y, LI YN, et al. Effect of serum HBV-DNA load on liver function and endoplasmic reticulum stress in peripheral blood in patients with hepatitis B[J]. Chin Gen Pract, 2018, 21( 27): 3329- 3333. DOI: 10.12114/j.issn.1007-9572.2018.00.121.

    刘芳, 闫宇, 李雅楠, 等. 血清乙型肝炎病毒-DNA载量对乙型肝炎患者肝功能及外周血内质网应激相关指标的影响研究[J]. 中国全科医学, 2018, 21( 27): 3329- 3333. DOI: 10.12114/j.issn.1007-9572.2018.00.121.
    [36]
    TSENG TC, HUANG LR. Immunopathogenesis of hepatitis B virus[J]. J Infect Dis, 216( suppl_8): S765- S770. DOI: 10.1093/infdis/jix356.
    [37]
    LU HH, CAO WH, ZHANG LX, et al. Effects of hepatitis B virus infection and strategies for preventing mother-to-child transmission on maternal and fetal T-cell immunity[J]. Front Immunol, 2023, 14: 1122048. DOI: 10.3389/fimmu.2023.1122048.
    [38]
    SONG AX, LIU YS, CAO ZH, et al. Clinical features and T cell immune characteristics of postpartum hepatitis flare in pregnant women with HBeAg-positive chronic HBV infection[J]. Front Immunol, 2022, 13: 881321. DOI: 10.3389/fimmu.2022.881321.
    [39]
    XIAO LX, CHEN YR, HUANG P, et al. The safety of antiviral therapy and drug withdrawal for the prevention of mother-to-child transmission of HBV during pregnancy[J]. J Med Virol, 2020, 92( 12): 3381- 3389. DOI: 10.1002/jmv.26011.
    [40]
    WU YY, CHENG C, LAI WJ, et al. The effect of tenofovir combined with peginterferon α‍-2b injection on HBeAg seroconversion rate and negative conversion rate in patients with chronic hepatitis B[J]. Prog Mod Biomed, 2021, 21( 10): 1938- 1941. DOI: 10.13241/j.cnki.pmb.2021.10.029.

    吴英英, 程聪, 赖文娟, 等. 替诺福韦联合聚乙二醇干扰素α-2b注射液对慢性乙型肝炎患者HBeAg血清学转换率和阴转率的影响[J]. 现代生物医学进展, 2021, 21( 10): 1938- 1941. DOI: 10.13241/j.cnki.pmb.2021.10.029.
    [41]
    PENG SX, WAN ZH, LIU TT, et al. Cesarean section reduces the risk of early mother-to-child transmission of hepatitis B virus[J]. Dig Liver Dis, 2018, 50( 10): 1076- 1080. DOI: 10.1016/j.dld.2018.05.004.
    [42]
    YANG J, ZENG XM, MEN YL, et al. Elective Caesarean section versus vaginal delivery for preventing mother to child transmission of hepatitis B virus: A systematic review[J]. Virol J, 2008, 5: 100. DOI: 10.1186/1743-422X-5-100.
    [43]
    YAO NJ, FU S, WU YC, et al. Incidence of mother-to-child transmission of hepatitis B in relation to maternal peripartum antiviral prophylaxis: A systematic review and meta-analysis[J]. Acta Obstet Gynecol Scand, 2022, 101( 11): 1197- 1206. DOI: 10.1111/aogs.14448.
    [44]
    ZHANG R, QIAN F, ZHU L, et al. Effect of blocking mother-to-child vertical transmission of HBV on selective cesarean section based on individualized scheme[J]. Mod Med J China, 2021, 23( 2): 37- 41. DOI: 10.3969/j.issn.1672-9463.2021.02.009.

    张荣, 钱峰, 朱莉, 等. 基于个体化方案的乙型肝炎病毒母婴垂直传播阻断对选择性剖宫产分娩的影响[J]. 中国现代医药杂志, 2021, 23( 2): 37- 41. DOI: 10.3969/j.issn.1672-9463.2021.02.009.
    [45]
    MA DM, ZHANG Y, ZHANG LN, et al. Correlation analysis between the duration of the second stage of labor and the intrapartum transmission of hepatitis B virus[J]. Matern Child Health Care China, 2018, 33( 14): 3156- 3158. DOI: 10.7620/zgfybj.j.issn.1001-4411.2018.14.11.

    马德明, 张玉, 张丽娜, 等. 第二产程时长与乙型肝炎病毒产时传播的相关性分析[J]. 中国妇幼保健, 2018, 33( 14): 3156- 3158. DOI: 10.7620/zgfybj.j.issn.1001-4411.2018.14.11.
    [46]
    ERTURK US, METE B, OZARAS R, et al. Plasma and breast milk pharmacokinetics of tenofovir disoproxil fumarate in nursing mother with chronic hepatitis B-infant pairs[J]. Antimicrob Agents Chemother, 2021, 65( 10): e0111021. DOI: 10.1128/AAC.01110-21.
    [47]
    KAYES T, CRANE H, SYMONDS A, et al. Plasma and breast milk pharmacokinetics of tenofovir alafenamide in mothers with chronic hepatitis B infection[J]. Aliment Pharmacol Ther, 2022, 56( 3): 510- 518. DOI: 10.1111/apt.17040.
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Tables(1)

    Article Metrics

    Article views (223) PDF downloads(57) Cited by()
    Proportional views
    Related

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return