title: Hepatic flare after telbivudine withdrawal and efficacy of postpartum antiviral therapy for pregnancies with chronic hepatitis B virus.
abstract: OBJECTIVE
  The efficacy of telbivudine for breaking vertical transmission of hepatitis B virus has been well established. Data on the risk of postpartum flare after telbivudine withdrawal and efficacy of extended antiviral therapy after delivery are limited.
  
  
  METHODS
  Chronic hepatitis B virus-infected women who received telbivudine beginning at week 24 or 28 of gestation were enrolled and then followed up to 52 weeks postpartum. Virological and biochemical parameters were assessed.
  
  
  RESULTS
  Of the 241 women who finished 52 weeks of follow-up, 33.6% had elevated serum alanine aminotransferase (ALT) during pregnancy. Telbivudine administration resulted in ALT normalization in 85.2% before delivery. Compared with women having a normal ALT level throughout pregnancy, those with elevated ALT had a significantly higher rate of ALT flare after telbivudine withdrawal (25.0% vs 11.9%; χ2= 4.273, P = 0.039). Multivariate analysis indicated that only ALT elevation during pregnancy correlated with postpartum flare after telbivudine withdrawal. Those women with elevated ALT during pregnancy continued antiviral treatment to 52 weeks postpartum and had a significantly higher HBeAg seroconversion rate (P = 0.001) and a notable decrease in HBsAg titers (P = 0.001).
  
  
  CONCLUSIONS
  It is safe for the majority of women to withdraw telbivudine after delivery, whereas exciting serological response encourages extended antiviral therapy for mother with ALT elevation during pregnancy.
authors.affiliation: The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China.
authors.forename: Jinfeng
authors.initials: J
authors.lastname: Liu
authors.affiliation: The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Wang
authors.affiliation: Shaanxi Kangfu Hospital, Xi'an, China.
authors.forename: Dongfang
authors.initials: D
authors.lastname: Jin
authors.affiliation: The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China.
authors.forename: Caijing
authors.initials: C
authors.lastname: Qi
authors.affiliation: The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China.
authors.forename: TaoTao
authors.initials: T
authors.lastname: Yan
authors.affiliation: The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China.
authors.forename: Furong
authors.initials: F
authors.lastname: Cao
authors.affiliation: The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China.
authors.forename: Li
authors.initials: L
authors.lastname: Jin
authors.affiliation: The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China.
authors.forename: Zhen
authors.initials: Z
authors.lastname: Tian
authors.affiliation: The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China.
authors.forename: Dandan
authors.initials: D
authors.lastname: Guo
authors.affiliation: The Second Affiliated Hospital of Shaanxi Traditional Chinese Medical College, Xianyang, China.
authors.forename: Ningxia
authors.initials: N
authors.lastname: Yuan
authors.affiliation: Shaanxi Sengong Hospital, Xi'an, China.
authors.forename: Weihong
authors.initials: W
authors.lastname: Feng
authors.affiliation: The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China.
authors.forename: Shulin
authors.initials: S
authors.lastname: Zhang
authors.affiliation: The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China.
authors.forename: Yingren
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China.
authors.forename: Tianyan
authors.initials: T
authors.lastname: Chen
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D000998:Antiviral Agents / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006513:Hepatitis B e Antigens / Q000097:blood; D019694:Hepatitis B, Chronic / Q000188:drug therapy* / Q000635:transmission / Q000821:virology; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D049590:Postpartum Period; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy* / Q000821:virology; D000077712:Telbivudine; D013936:Thymidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D006513:Hepatitis B e Antigens; D000077712:Telbivudine; D000410:Alanine Transaminase; D013936:Thymidine
keywords: chronic HBV; extended antiviral therapy; postpartum hepatic flare