title: Outcome after discontinuing antiviral agents during pregnancy in women infected with hepatitis B virus.
abstract: BACKGROUND
  Women who are taking antiviral agents and become pregnant have several options that include, continuing therapy, ceasing drugs, or switching to safer drugs. However, there are limited data on the outcome in pregnant women after withdrawal of antiviral agents.
  
  
  OBJECTIVE
  We aimed to investigate the outcome of stopping antiviral agents in pregnant women with chronic hepatitis B virus (HBV) infection.
  
  
  METHODS
  In this single-center, retrospective cohort study, 12 pregnant patients who had received antiviral therapy for HBV and cease drugs after awareness of pregnancy between 2003 and 2010 were enrolled. We retrospectively studied virologic and biochemical flares during pregnancy and postpartum period.
  
  
  RESULTS
  Median age at pregnancy was 30.5 (range, 24-35) years, median duration of antiviral drug before pregnancy was 15.3 (range, 3.0-131.3) months, and median HBV DNA at withdrawal of therapy was 4.8 (range, 1.7-8.0) log(10) copies/mL. Eight out of twelve patients (66.7%) had a viral rebound after stopping antiviral drugs during pregnancy. Severe hepatitis flares, defined as a 5-fold increase in serum alanine aminotransferase (ALT), were observed in six patients (50%) during pregnancy. However, all of these patients spontaneously recovered without an event of hepatic decompensation. High pretreatment ALT was associated with severe hepatitis flares after cessation of therapy during pregnancy. Five patients with at least 1-year treatment before pregnancy maintained low hepatitis activity after delivery.
  
  
  CONCLUSIONS
  Pregnant women with high pretreatment ALT or those treated less than 1 year before pregnancy have high risk of severe hepatitis flares after cessation of antiviral agents.
authors.affiliation: Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
authors.forename: Hee Yeon
authors.initials: HY
authors.lastname: Kim
authors.forename: Jong Young
authors.initials: JY
authors.lastname: Choi
authors.forename: Chung-Hwa
authors.initials: CH
authors.lastname: Park
authors.forename: Jeong Won
authors.initials: JW
authors.lastname: Jang
authors.forename: Chang Wook
authors.initials: CW
authors.lastname: Kim
authors.forename: Si Hyun
authors.initials: SH
authors.lastname: Bae
authors.forename: Seung Kew
authors.initials: SK
authors.lastname: Yoon
authors.forename: Jin Mo
authors.initials: JM
authors.lastname: Yang
authors.forename: Chang Don
authors.initials: CD
authors.lastname: Lee
authors.forename: Young Sok
authors.initials: YS
authors.lastname: Lee
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D000998:Antiviral Agents / Q000494:pharmacology*; D015415:Biomarkers / Q000097:blood; D004279:DNA, Viral / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006515:Hepatitis B virus; D019694:Hepatitis B, Chronic / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D019259:Lamivudine / Q000494:pharmacology; D049590:Postpartum Period; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy* / Q000821:virology*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D019562:Viral Load; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D015415:Biomarkers; D004279:DNA, Viral; D019259:Lamivudine; D000410:Alanine Transaminase