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. 2021 Nov 15;15(6):887-894.
doi: 10.5009/gnl21001.

Clinical and Immunological Factors Associated with Postpartum Hepatic Flares in Immune-Tolerant Pregnant Women with Hepatitis B Virus Infection Treated with Telbivudine

Junfeng Lu  1 , Xiaoxiao Wang  1 , Yunxia Zhu  2 , Lina Ma  1 , Sujun Zheng  1 , Zhongjie Hu  1 , Xinyue Chen  1
Affiliations

Clinical and Immunological Factors Associated with Postpartum Hepatic Flares in Immune-Tolerant Pregnant Women with Hepatitis B Virus Infection Treated with Telbivudine

Junfeng Lu et al. Gut Liver. .

Abstract

Background/aims: To investigate postpartum hepatic flares and associated factors in highly viremic pregnant patients in the immune tolerance phase who adopted telbivudine (LdT) treatment in the last trimester to reduce vertical transmission of hepatitis B virus.

Methods: Hepatitis B e antigen (HBeAg)-positive, highly viremic pregnant women were recruited for this prospective study. Treatment with LdT was started from 28 weeks of gestation. Virological and biochemical markers were examined before LdT treatment, antepartum and postpartum. Serial blood samples at the same time were collected to detect cytokines and cortisol (COR).

Results: Fifty-six of 153 patients (36.6%) had postpartum hepatic flares, defined as a 2-fold increase in alanine aminotransferase 6 weeks after delivery. Age and the antepartum alanine aminotransferase and postpartum HBeAg levels were independent influencing factors of postpartum hepatic flares. Cytokines showed no regularity during or after pregnancy. Compared with the patients with no postpartum flares, the patients with flares had lower baseline interferon γ and COR levels (p=0.022 and p=0.028) and higher postpartum interferon γ levels (p=0.026).

Conclusions: A high proportion of highly viremic and immune-tolerant pregnant patients treated with LdT in the last trimester had postpartum hepatic flares, which implied that these patients entered the immune clearance phase after delivery. Thus, this may create an appropriate opportunity for re-antiviral therapy.

Keywords: Hepatic flares; Hepatitis B; Immune tolerance; Postpartum; Pregnancy.

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Conflict of interest statement

CONFLICTS OF INTEREST

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1
Changes in aminotransferase (ALT) levels before and after delivery. (A) Changes in alanine ALT levels at baseline, antepartum and postpartum in all the patients. (B) Postpartum ALT levels in those who stopped telbivudine (LdT) immediately after (group A, n=103) or 6 weeks after delivery (group B, n=50).
Fig. 2
Fig. 2
Virological changes before and after delivery. (A) Changes in HBV DNA levels before LdT, antepartum and postpartum. (B) Changes in HBeAg levels before LdT and postpartum. HBV, hepatitis B virus; LdT, telbivudine; HBeAg, hepatitis B e antigen; COI, cutoff index.
Fig. 3
Fig. 3
Changes in cytokines and COR at baseline, antepartum and postpartum. IL, interleukin; IFN, interferon; TNF, tumor necrosis factor; COR, cortisol.
See this image and copyright information in PMC

Comment in

References

    1. Cui F, Luo H, Wang F, et al. Evaluation of policies and practices to prevent mother to child transmission of hepatitis B virus in China: results from China GAVI project final evaluation. Vaccine. 2013;31 Suppl 9:J36–J42. doi: 10.1016/j.vaccine.2012.11.061. - DOI - PubMed
    1. Wiseman E, Fraser MA, Holden S, et al. Perinatal transmission of hepatitis B virus: an Australian experience. Med J Aust. 2009;190:489–492. doi: 10.5694/j.1326-5377.2009.tb02524.x. - DOI - PubMed
    1. Xu WM, Cui YT, Wang L, et al. Lamivudine in late pregnancy to prevent perinatal transmission of hepatitis B virus infection: a multicentre, randomized, double-blind, placebo-controlled study. J Viral Hepat. 2009;16:94–103. doi: 10.1111/j.1365-2893.2008.01056.x. - DOI - PubMed
    1. Zou H, Chen Y, Duan Z, Zhang H, Pan C. Virologic factors associated with failure to passive-active immunoprophylaxis in infants born to HBsAg-positive mothers. J Viral Hepat. 2012;19:e18–e25. doi: 10.1111/j.1365-2893.2011.01492.x. - DOI - PubMed
    1. Zhang H, Pan CQ, Pang Q, Tian R, Yan M, Liu X. Telbivudine or lamivudine use in late pregnancy safely reduces perinatal transmission of hepatitis B virus in real-life practice. Hepatology. 2014;60:468–476. doi: 10.1002/hep.27034. - DOI - PMC - PubMed