title: Analysis of residual perinatal transmission of hepatitis B virus (HBV) and of genetic variants in human immunodeficiency virus and HBV co-infected women and their offspring.
abstract: BACKGROUND
  Despite implementation of universal infant hepatitis B (HB) vaccination, mother-to-child transmission (MTCT) of hepatitis B virus (HBV) still occurs. Limited data are available on the residual MTCT of HBV in human immunodeficiency virus (HIV)-HBV co-infected women.
  
  
  OBJECTIVE
  We assessed the prevalence of HBV infection among HIV-infected pregnant women and the rate of residual MTCT of HBV from HIV-HBV co-infected women and analyzed the viral determinants in mothers and their HBV-infected children.
  
  
  METHODS
  HIV-1 infected pregnant women enrolled in two nationwide perinatal HIV prevention trials in Thailand were screened for HB surface antigen (HBsAg) and tested for HBeAg and HBV DNA load. Infants born to HBsAg-positive women had HBsAg and HBV DNA tested at 4-6 months. HBV diversity within each HBV-infected mother-infant pair was analyzed by direct sequencing of amplified HBsAg-encoding gene and cloning of amplified products.
  
  
  RESULTS
  Among 3312 HIV-1 infected pregnant women, 245 (7.4%) were HBsAg-positive, of whom 125 were HBeAg-positive. Of 230 evaluable infants born to HBsAg-positive women, 11 (4.8%) were found HBsAg and HBV DNA positive at 4-6 months; 8 were born to HBeAg-positive mothers. HBV genetic analysis was performed in 9 mother-infant pairs and showed that 5 infants were infected with maternal HBV variants harboring mutations within the HBsAg "a" determinant, and four were infected with wild-type HBV present in highly viremic mothers.
  
  
  CONCLUSIONS
  HBV-MTCT still occurs when women have high HBV DNA load and/or are infected with HBV variants. Additional interventions targeting highly viremic women are thus needed to reduce further HBV-MTCT.
authors.affiliation: Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand; INSERM U966, CHRU Tours, Faculté de Médecine, Université François-Rabelais, Tours, France; Institut de Recherche pour le Développement (IRD) UMI 174/Programs for HIV Prevention and Treatment (PHPT), Chiang Mai, Thailand.
authors.forename: Woottichai
authors.initials: W
authors.lastname: Khamduang
authors.forename: Catherine
authors.initials: C
authors.lastname: Gaudy-Graffin
authors.forename: Nicole
authors.initials: N
authors.lastname: Ngo-Giang-Huong
authors.forename: Gonzague
authors.initials: G
authors.lastname: Jourdain
authors.forename: Alain
authors.initials: A
authors.lastname: Moreau
authors.forename: Thitiporn
authors.initials: T
authors.lastname: Borkird
authors.forename: Prapaisri
authors.initials: P
authors.lastname: Layangool
authors.forename: Nareerat
authors.initials: N
authors.lastname: Kamonpakorn
authors.forename: Weerachai
authors.initials: W
authors.lastname: Jitphiankha
authors.forename: Ratchanee
authors.initials: R
authors.lastname: Kwanchaipanich
authors.forename: Sathit
authors.initials: S
authors.lastname: Potchalongsin
authors.forename: Marc
authors.initials: M
authors.lastname: Lallemant
authors.forename: Wasna
authors.initials: W
authors.lastname: Sirirungsi
authors.forename: Alain
authors.initials: A
authors.lastname: Goudeau
mesh_terms: D000328:Adult; D004279:DNA, Viral / Q000097:blood; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006513:Hepatitis B e Antigens / Q000097:blood; D006515:Hepatitis B virus / Q000302:isolation & purification*; D019694:Hepatitis B, Chronic / Q000150:complications* / Q000453:epidemiology / Q000635:transmission*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000821:virology*; D015995:Prevalence; D013785:Thailand / Q000453:epidemiology; D055815:Young Adult
chemical_list: D004279:DNA, Viral; D006514:Hepatitis B Surface Antigens; D006513:Hepatitis B e Antigens
keywords: 95% confidence interval; 95%CI; DNA; EPI; HB; HBIg; HBV; HBeAg; HBs antigen variants; HBsAg; HIV; HIV pregnant women; Hepatitis B vaccine failure; IQR; MTCT; Mother-to-child transmission; PCR; Thailand; deoxyribonucleic acid; expanded program on immunization; hepatitis B; hepatitis B immune globulin; hepatitis B virus; human immunodeficiency virus; interquartile range; mother-to-child transmission; polymerase chain reaction; the surface antigen of the hepatitis B virus; the “e” antigen of the hepatitis B virus
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