Management of Chronic Hepatitis B in Pregnancy - Tenofovir or Lamivudine?
Background: Despite active and passive immunization of the newborn, the rate of vertical
transmission of Hepatitis B (HBV) is as high as 10% in mothers with viral load >108 IU/ml.
Although oral antiviral therapy is recommended for pregnant women with high viral load in
the third trimester of pregnancy, there is little consensus on the level of HBV DNA and type
of antiviral agent to be used. While Lamivudine and Tenofovir are both efficacious in
reducing vertical transmission, the cost-benefit analysis data are not available.
Aims: (1) To evaluate the practices in the treatment of pregnant women with HBV in our
institution (2) To develop practical guidelines in management of these patients.
Materials and Methods: Retrospective analysis of pregnant patients referred from King
Edward Memorial Hospital for women, using our hepatitis B database. Patients who were
referred were fast-tracked into the hepatitis clinic prior to the third trimester. Patients with
HBV viral load >106 IU/ml were treated with oral antiviral therapy (Lamivudine or
Tenofovir) during the third trimester and for three months post partum.
Results: 35 patients with chronic hepatitis B were seen at the Royal Perth Hospital from
January 2012 to May 2013. 14 patients (40%) with period of gestation >24 weeks had HBV
viral load of >108 IU/ml. 1 patient had HBV viral load 105 IU/ml and the rest were below 104
IU/ml. Patients with HBV viral load ≥106 IU/ml were considered for treatment. All patients
treated had HBV viral load >108 IU/ml, 8 of whom were started on Lamivudine 100 mg daily
and 6 on Tenofovir 300 mg daily. Of the 14 patients, pre-delivery viral load was assessed in 6
patients. 3 patients on Lamivudine and 2 on Tenofovir, tested 2-6 weeks prior to delivery had
successfully reduced their viral load to <105 IU/ml.
Conclusion: In our small cohort of patients, both Lamivudine and Tenofovir are effective in
reducing HBV DNA from >108 IU/ml to <105 IU/ml, below the level recommended in order
to reduce the risk of vertical transmission of HBV. The study is ongoing to assess the efficacy
of both Lamivudine and Tenofovir in reducing HBV DNA to an acceptable level to reduce
vertical transmission and to develop strategic guidelines in the treatment of these patients,
taking into account cost-benefit analysis.