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Extending HBV therapy beyond birth does not protect against post-partum flare

This month's Alimentary Pharmacology & Therapeutics examines the use of anti-viral therapy for prevention of perinatal HBV transmission.

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Antepartum anti-viral therapy (AVT) is often administered to prevent perinatal transmission of hepatitis B virus (HBV) infection.

Little is known about the effect of AVT on post-partum flare rates and severity.

Dr Levy and colleagues from Australia examined whether extending AVT beyond birth influences the post-partum course.

The research team evaluated 101 pregnancies in 91 women with HBV DNA levels ≥log 7 IU/mL.

AVT (initially lamivudine, later tenofovir disoproxil fumarate) was commenced from 32 weeks gestation and stopped soon after birth and at 12 weeks post-partum.

Outcomes according to post-partum treatment duration were examined, with Group 1 receiving AVT for 4 weeks or less, Group 2 receiving AVT for more than 4 weeks, and Group 3 receiving no AVT.

The majority of women were HBeAg+, median age 29 years, baseline HBV DNA log 8.0 IU/mL, and follow-up 48 weeks post-partum.

HBeAg seroconversion was not associated with treatment duration
Alimentary Pharmacology & Therapeutics

Post-partum treatment duration was 2 weeks for Group 1, and 12 weeks for Group 2.

The research team found that flare rates were not significantly different between the groups.

Onset of flare was similar at 8/10/9 weeks post-partum for all groups.

The team noted that the majority of flares spontaneously resolved.

The research team observed that HBeAg seroconversion was not associated with treatment duration or the occurrence of a post-partum flare.

Dr Levy's team concludes, "Post-partum flares are common and usually arise early after delivery."

"They are often mild in severity and most spontaneously resolve."

"Extending anti-viral therapy does not protect against post-partum flares or affect HBeAg seroconversion rates."

Aliment Pharmacol Ther 2014: 39(10: 1225–1234
13 May 2014

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