title: Anti-viral therapy for prevention of perinatal HBV transmission: extending therapy beyond birth does not protect against post-partum flare.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  To examine whether extending AVT beyond birth influences the post-partum course.
  
  
  METHODS
  One hundred and one pregnancies in 91 women with HBV DNA levels ≥log 7 IU/mL were included. 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: Group 1 = AVT ≤4 weeks (n = 44), Group 2 = AVT >4 weeks (n = 43), Group 3 = no AVT (n = 14).
  
  
  RESULTS
  The majority of women were HBeAg+ (97%), median age 29 years, baseline HBV DNA log 8.0 IU/mL and follow-up 48 weeks post-partum. Post-partum treatment duration was 2 weeks for Group 1 and 12 weeks for Group 2, P < 0.01. Flare rates were not significantly different: Group 1 = 22/44 (50%), Group 2 = 17/43 (40%) and Group 3 = 4/14 (29%), P = 0.32. Onset of flare was similar at 8/10/9 weeks post-partum for Groups 1/2/3 respectively, P = 0.34. The majority of flares spontaneously resolved. HBeAg seroconversion (n = 1/5/1 in Groups 1/2/3, P = 0.27) was not associated with treatment duration or the occurrence of a post-partum flare.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Liverpool Hospital, Sydney, NSW, Australia.
authors.forename: V
authors.initials: V
authors.lastname: Nguyen
authors.forename: P K
authors.initials: PK
authors.lastname: Tan
authors.forename: A-J
authors.initials: AJ
authors.lastname: Greenup
authors.forename: A
authors.initials: A
authors.lastname: Glass
authors.forename: S
authors.initials: S
authors.lastname: Davison
authors.forename: D
authors.initials: D
authors.lastname: Samarasinghe
authors.forename: S
authors.initials: S
authors.lastname: Holdaway
authors.forename: S I
authors.initials: SI
authors.lastname: Strasser
authors.forename: U
authors.initials: U
authors.lastname: Chatterjee
authors.forename: K
authors.initials: K
authors.lastname: Jackson
authors.forename: S A
authors.initials: SA
authors.lastname: Locarnini
authors.forename: M T
authors.initials: MT
authors.lastname: Levy
mesh_terms: D000225:Adenine / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006513:Hepatitis B e Antigens / Q000276:immunology; D006515:Hepatitis B virus / Q000302:isolation & purification; D019694:Hepatitis B, Chronic / Q000188:drug therapy* / Q000635:transmission; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D019259:Lamivudine / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D063065:Organophosphonates / Q000008:administration & dosage / Q000627:therapeutic use; D049590:Postpartum Period; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy / Q000821:virology; D011446:Prospective Studies; D012720:Severity of Illness Index; D000068698:Tenofovir; D013997:Time Factors; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D006513:Hepatitis B e Antigens; D063065:Organophosphonates; D019259:Lamivudine; D000068698:Tenofovir; D000225:Adenine