title: Hepatitis B virus mother-to-child transmission among HIV-infected women receiving lamivudine-containing antiretroviral regimens during pregnancy and breastfeeding.
abstract: The study included 309 HIV-infected pregnant women receiving a lamivudine-containing antiretroviral regimen from week 25 of gestational age until 6 months postpartum, during breastfeeding. Twenty-seven of them (8.7%) were hepatitis B virus surface antigen (HBsAg) positive; at baseline, hepatitis B virus (HBV) DNA levels >3 log(10) IU/mL (with a median level of 6.2 log(10) IU/mL) were found in 10 women, who at one, three and six months postpartum had median levels of 5.2 log(10) IU/mL, 4.5 log(10) IU/mL and 2.8 log(10) IU/mL, respectively. Twenty-four of the 30 breast milk samples evaluated had undetectable HBV DNA and the other six had values between 15 and 155 IU/mL. Median lamivudine concentrations were 1070 ng/mL in serum and 684 ng/mL in breast milk. Among the 24 HBV-exposed children with available samples, 16 always tested negative, four had a transient infection, one had an undetermined status and three (12.5%) first tested positive at Month 12 or Month 24. Among the children born to the HBV-uninfected mothers of the same cohort, the rate of HBsAg positivity at 12-24 months was 2% (4/196). Our finding of the absence of significative levels of HBV DNA in the breast milk of co-infected mothers supports the present recommendations for breastfeeding in HBV-infected women. Horizontal transmission can be hypothesized for the infections detected in children at 12-24 months. Children born to HBV-positive mothers remained at higher risk of postnatal HBV acquisition compared to those born to HBV-negative women.
authors.affiliation: Department of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanità, Rome, Italy.
authors.forename: M F
authors.initials: MF
authors.lastname: Pirillo
authors.forename: P
authors.initials: P
authors.lastname: Scarcella
authors.forename: M
authors.initials: M
authors.lastname: Andreotti
authors.forename: H
authors.initials: H
authors.lastname: Jere
authors.forename: E
authors.initials: E
authors.lastname: Buonomo
authors.forename: J-B
authors.initials: JB
authors.lastname: Sagno
authors.forename: R
authors.initials: R
authors.lastname: Amici
authors.forename: M G
authors.initials: MG
authors.lastname: Mancini
authors.forename: P
authors.initials: P
authors.lastname: Leone
authors.forename: S
authors.initials: S
authors.lastname: Ceffa
authors.forename: S
authors.initials: S
authors.lastname: Mancinelli
authors.forename: M C
authors.initials: MC
authors.lastname: Marazzi
authors.forename: S
authors.initials: S
authors.lastname: Vella
authors.forename: L
authors.initials: L
authors.lastname: Palombi
authors.forename: M
authors.initials: M
authors.lastname: Giuliano
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D001942:Breast Feeding / Q000009:adverse effects; D002648:Child; D060085:Coinfection; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D006509:Hepatitis B / Q000635:transmission* / Q000821:virology; D006515:Hepatitis B virus; D006801:Humans; D018445:Infectious Disease Transmission, Vertical; D019259:Lamivudine / Q000627:therapeutic use*; D008297:Male; D011247:Pregnancy; D012307:Risk Factors; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents; D019259:Lamivudine
keywords: Africa; HIV; breastfeeding; hepatitis B virus; lamivudine; perinatal transmission