title: Post-partum reactivation of chronic hepatitis B virus infection among hepatitis B e-antigen-negative women.
abstract: OBJECTIVE
  To investigate the frequency and timing of post-partum chronic hepatitis B virus (HBV) reactivation and identify its pre-partum predictors.
  
  
  METHODS
  Forty-one hepatitis B e antigen (HBeAg)-negative chronic HBV infected pregnant women were prospectively evaluated between the 28th and the 32nd week of gestation. Subjects were re-evaluated at 3-mo intervals during the first post-partum year and every 6 mo during the following years. HBV DNA was determined using real-time reverse transcription polymerase chain reaction (Cobas TaqMan HBV Test) with a lower detection limit of 8 IU/mL. Post-partum reactivation (PPR) was defined as abnormal alanine aminotransaminase (ALT) levels and HBV DNA above 2000 IU/mL.
  
  
  RESULTS
  Fourteen out of 41 women (34.1%) had pre-partum HBV DNA levels>2000 IU/mL, 18 (43.9%) had levels<2000 IU/mL and 9 (21.9%) had undetectable levels. Fourteen women were lost to follow-up (failure to return). PPR occurred in 8 of the 27 (29.6%) women evaluated, all within the first 6 mo after delivery (5 at month 3; 3 at month 6). Five of the 6 (83.3%) women with pre-partum HBV DNA>10000 IU/mL exhibited PPR compared with 3 of the 21 (14.3%) women with HBV DNA<10000 IU/mL (two with HBV DNA>2000 and the third with HBV DNA of 1850 IU/mL), P=0.004. An HBV DNA level≥10000 IU/mL independently predicted post-partum HBV infection reactivation (OR=57.02, P=0.033). Mean pre-partum ALT levels presented a non-significant increase in PPR cases (47.3 IU/L vs 22.2 IU/L, respectively, P=0.094).
  
  
  CONCLUSIONS
  In the present study, PPR occurred in approximately 30% of HBeAg-negative pregnant women; all events were observed during the first semester after delivery. Pre-partum HBV DNA level>10000 IU/mL predicted PPR.
authors: Ioannis Elefsiniotis, Elena Vezali, Dimitrios Vrachatis, Sofia Hatzianastasiou, University Department of Internal Medicine-Hepatology Unit, Maternal and Perinatal Hospital "Elena Venizelou", 11521 Athens, Greece.
authors: Ioannis
authors: I
authors: Elefsiniotis
authors: Ioannis Elefsiniotis, Elena Vezali, Dimitrios Vrachatis, Sofia Hatzianastasiou, University Department of Internal Medicine-Hepatology Unit, Maternal and Perinatal Hospital "Elena Venizelou", 11521 Athens, Greece.
authors: Elena
authors: E
authors: Vezali
authors: Ioannis Elefsiniotis, Elena Vezali, Dimitrios Vrachatis, Sofia Hatzianastasiou, University Department of Internal Medicine-Hepatology Unit, Maternal and Perinatal Hospital "Elena Venizelou", 11521 Athens, Greece.
authors: Dimitrios
authors: D
authors: Vrachatis
authors: Ioannis Elefsiniotis, Elena Vezali, Dimitrios Vrachatis, Sofia Hatzianastasiou, University Department of Internal Medicine-Hepatology Unit, Maternal and Perinatal Hospital "Elena Venizelou", 11521 Athens, Greece.
authors: Sofia
authors: S
authors: Hatzianastasiou
authors: Ioannis Elefsiniotis, Elena Vezali, Dimitrios Vrachatis, Sofia Hatzianastasiou, University Department of Internal Medicine-Hepatology Unit, Maternal and Perinatal Hospital "Elena Venizelou", 11521 Athens, Greece.
authors: Stefanos
authors: S
authors: Pappas
authors: Ioannis Elefsiniotis, Elena Vezali, Dimitrios Vrachatis, Sofia Hatzianastasiou, University Department of Internal Medicine-Hepatology Unit, Maternal and Perinatal Hospital "Elena Venizelou", 11521 Athens, Greece.
authors: George
authors: G
authors: Farmakidis
authors: Ioannis Elefsiniotis, Elena Vezali, Dimitrios Vrachatis, Sofia Hatzianastasiou, University Department of Internal Medicine-Hepatology Unit, Maternal and Perinatal Hospital "Elena Venizelou", 11521 Athens, Greece.
authors: Georgia
authors: G
authors: Vrioni
authors: Ioannis Elefsiniotis, Elena Vezali, Dimitrios Vrachatis, Sofia Hatzianastasiou, University Department of Internal Medicine-Hepatology Unit, Maternal and Perinatal Hospital "Elena Venizelou", 11521 Athens, Greece.
authors: Athanasios
authors: A
authors: Tsakris
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D004279:DNA, Viral / Q000097:blood; D005260:Female; D006513:Hepatitis B e Antigens / Q000097:blood*; D006515:Hepatitis B virus / Q000235:genetics / Q000276:immunology*; D019694:Hepatitis B, Chronic / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology / Q000821:virology*; D006801:Humans; D049590:Postpartum Period; D011247:Pregnancy; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D019562:Viral Load; D014775:Virus Activation; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D015415:Biomarkers; D004279:DNA, Viral; D006513:Hepatitis B e Antigens
keywords: Hepatitis B; Hepatitis B virus-DNA; Post-Partum; Pregnancy; Reactivation
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