Chronic hepatitis B in pregnant women: is hepatitis B surface antigen quantification useful for viral load prediction?. (December 2015)

• Record Type: Journal Article
• Authors: Fujiko, Masita; Chalid, Maisuri T.; Turyadi, ; Ie, Susan I.; Maghfira, ; Syafri, ; Wahyuni, Ridha; Roni, Martono; Patellongi, Ilhamjaya; Massi, M. Nasrum; Muljono, David H.
• Is Part Of: International journal of infectious diseases. Volume 41(2015:Dec.)
• Page Start: 83
• Page End: 89
• Publication Date: 2015-12
• Subjects: HBsAg level -- HBV DNA level -- Pregnant women -- HBV vertical transmission -- Mother-to-child-transmission; Communicable diseases -- Periodicals; Communicable Diseases -- Periodicals; Communicable diseases; Periodicals; Electronic journals; 616.9
• DOI: 10.1016/j.ijid.2015.11.002
• Languages: English
• ISSNs: 1201-9712

Abstract

Highlights: Perinatal transmission of hepatitis B virus (HBV) still occurs despite infant hepatitis B vaccination. Maternal HBV viraemia is the main risk factor for perinatal transmission. The hepatitis B surface antigen (HBsAg) level is a good viral load predictor in hepatitis B e antigen (HBeAg)-positive pregnant women. HBeAg-negative status could be due to HBV variants defective for HBeAg production. HBV DNA quantification is not required for pregnant women with low HBsAg levels. Summary: Background: New cases of hepatitis B virus (HBV) infection continue to occur worldwide. Most of these are due to mother-to-child transmission (MTCT), with maternal viraemia as the most important contributing factor. The hepatitis B surface antigen (HBsAg) level, which correlates positively with viral load, has been used for treatment monitoring in chronic hepatitis B. This study evaluated the usefulness of quantitative HBsAg for viral load prediction in HBsAg-positive pregnant women. Methods: A total of 943 pregnant women in Makassar, Indonesia, were screened for HBsAg. Sixty-four women were HBsAg-positive and investigated. HBsAg level and hepatitis B e antigen (HBeAg)/hepatitis B e antibody (anti-HBe) status were determined serologically. Viral load was measured by real-time PCR. HBV DNA was sequenced and analysed for identification of genotype and basal core promoter (BCP)/precore (PC) mutations. Results: Of 64 subjects, 12 (18.8%) were HBeAg-positive and 52 (81.3%) were HBeAg-negative. HBsAg and HBV DNA levels were significantly higher in the HBeAg-positive group ( p < 0.001). HBsAg and HBV DNA levels were positively correlated in the HBeAg-positive group ( r = 0.659; p = 0.02), but not in the HBeAg-negative group ( r = 0.194; p = 0.168). Low HBsAg levels (<3.0 log10 IU/ml) corresponded with HBV DNA levels < 6.0 log10 IU/ml ( r = 0.404; p = 0.001), a recognized threshold for MTCT. Genotype C was more prevalent than genotype B, but not associated with HBsAg level, viral load, or HBeAg status. Two-thirds of HBeAg-negative subjects with high HBV DNA levels harboured BCP (A1762T/G1764A) and/or PC (G1896A) variants. Conclusions: HBsAg levels provide a good viral load predictor in HBeAg-positive but not HBeAg-negative pregnant women. The HBeAg-negative group had a frequent occurrence of BCP/PC variants, which may have contributed to the lack of correlation observed. Samples with a low HBsAg level, which is associated with a low risk of MTCT, do not require HBV DNA measurement.