title: Lamivudine treatment during pregnancy to prevent perinatal transmission of hepatitis B virus infection.
abstract: Vertical transmission of hepatitis B virus (HBV) can occur occasionally despite vaccination of the child. This vaccination breakthrough has been associated with high maternal viraemia. We treated eight highly viraemic (HBV-DNA >/= 1.2 x 10(9) geq/mL) mothers with 150 mg of lamivudine daily during the last month of pregnancy. HBV-DNA, hepatitis B surface antigen (HBsAg), anti-HBs and anti-HBc of their offspring were measured at birth and at 3, 6 and 12 months, respectively. Twenty-four children, born to untreated HBsAg-positive mothers with HBV-DNA levels >/=1.2 x 10(9) geq/mL served as historical controls. All children received passive-active immunization at birth and were followed-up for 12 months. In the lamivudine group one of the eight children (12.5%) was still HBsAg and HBV-DNA positive at the age of 12 months. All other children seroconverted to anti-HBs and maintained seroprotection. In three children, HBV-DNA was temporarily detected by polymerase chain reaction. In the untreated historical control group, perinatal transmission occurred in seven of 25 children (28%). In highly viraemic HBsAg-positive mothers, reduction of viraemia by lamivudine therapy in the last month of pregnancy may be an effective and safe measure to reduce the risk of child vaccination breakthrough. This approach should be evaluated in a large controlled trial.
authors.affiliation: Department of Gastroenterology and Hepatology; Department of Virology, Erasmus Medical Center Rotterdam, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: van Zonneveld
authors.forename: A B
authors.initials: AB
authors.lastname: van Nunen
authors.forename: H G M
authors.initials: HG
authors.lastname: Niesters
authors.forename: R A
authors.initials: RA
authors.lastname: de Man
authors.forename: S W
authors.initials: SW
authors.lastname: Schalm
authors.forename: H L A
authors.initials: HL
authors.lastname: Janssen
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006509:Hepatitis B / Q000175:diagnosis / Q000188:drug therapy* / Q000635:transmission*; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D019259:Lamivudine / Q000008:administration & dosage*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis / Q000188:drug therapy*; D011256:Pregnancy Outcome; D011336:Probability; D011446:Prospective Studies; D012016:Reference Values; D018894:Reverse Transcriptase Inhibitors / Q000008:administration & dosage*; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D018894:Reverse Transcriptase Inhibitors; D019259:Lamivudine