Management of chronic hepatitis B in pregnancy

Pregnancy associated with chronic hepatitis B (CHB) is a common and important problem with unique challenges. Pregnant women infected with CHB are different from the general population, and their special problems need to be considered: such as the effect of hepatitis B virus (HBV) infection on the mother and fetus, the effect of pregnancy on replication of the HBV, whether mothers should take HBV antiviral therapy during pregnancy, the effect of these treatments on the mother and fetus, how to carry out immunization of neonates, whether it can induce hepatitis activity after delivery and other serious issues. At present, there are about 350 million individuals with HBV infection worldwide, of which 50% were infected during the perinatal or neonatal period, especially in HBV-endemic countries. Currently, the rate of HBV infection in thechild-bearing age group is still at a high level, and the infection rate is as high as 8.16%. Effective prevention of mother-to-child transmission is an important means of reducing the global burden of chronic HBV infection. Even after adopting the combined immunization measures, there are still 5%-10% of babies born with HBV infection in hepatitis B e antigen positive pregnant women. As HBV perinatal transmission is the main cause of chronic HBV infection, we must consider how to prevent this transmission to reduce the burden of HBV infection. In this population of chronic HBV infected women of childbearing age, specific detection, intervention and follow-up measures are particularly worthy of attention and discussion.

A randomized double-blind placebo-controlled study of lamivudine in the treatment of patients with chronic hepatitis B virus infection

Objective To evaluate the effect of lamivudine on the loss of serum he patitis B virus (HBV) DNA, HBeAg/antiHBe seroconversion and ALT levels in chron ic hepatitis B patients and its safety profile and tolerance compared with place bo.Methods Four hundred and twenty nine patients with chronic HBV infecti on as defined by positive HBsAg, HBeAg and HBV DNA were enrolled and randomized into lamivudine and placebo groups. Three hundred and twenty two patients recei ved lamivudine 100?mg daily and 107 patients received placebo treatment for 12 weeks. Then, all patients were offered a further 9 month open label lamivudine treatment. The efficacy and safety were evaluated with clinical, biochemical, hematological and virological parameters. Results During the 12 week treatment period, 92.2% of lamivudine t reate d patients became HBV DNA negative (below 1.6?pg/ml) compared with only 14.1% o f those receiving placebo (P<0.01). At the end of 12 week, the sust ained negative rate for HBV DNA in the lamivudine treated group was 78.5% compar ed with the placebo group (11.1%; P< 0.01). There was a trend to a high proportion of patients treated with lamivudine to lose HBeAg (8.1%) and d evelop antiHBe (10.2%) than treated with placebo (5.3% and 6.4% respectively), b ut this difference was not statistically significant. Patients with elevated AL T levels at baseline became normal in 60.3% of the lamivudine treated group comp ared with the placebo group where only 27.5% were normal (P<0.01). L amivudine was well tolerated in a dose of (100?mg daily) and the overall incide nce of adverse events was similar to that of the placebo. Conclusions Lamivudine (100 mg daily) is very effective in the inhibiti on of HBV replication, indicated by the rapid loss of serum HBV DNA, and often acco mpanied by a decrease of serum ALT levels. Lamivudine is well tolerated withou t severe adverse events during treatment.