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J Hepatol. 2013 Jul;59(1):24-30. doi: 10.1016/j.jhep.2013.02.015. Epub 2013 Feb 26.

Mother-to-infant transmission of hepatitis B virus infection: significance of maternal viral load and strategies for intervention.

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  • 1Department of Pediatrics, Cardinal Tien Hospital, New Taipei City, Taiwan.

Abstract

BACKGROUND & AIMS:

Immunoprophylaxis reduces but does not completely eradicate hepatitis B virus (HBV) transmission. This prospective study aims at assessing the rate and risk factors of maternally transmitted HBV infection.

METHODS:

We enrolled 303 mother-infant pairs with positive maternal hepatitis B surface antigen (HBsAg) under current immunization program. Maternal viral load was determined by a real-time PCR-based assay. The children were tested for HBsAg at 4-8 months and/or 1-3 years of age. Rates of HBV infection were estimated using a multivariate logistic regression model.

RESULTS:

HBeAg-positive mothers (81/303, 26.7%) had higher viral loads than HBeAg-negative mothers (7.4 ± 1.9 vs. 2.7 ± 1.4 log10 copies/ml, p<0.0001). Ten children, born to HBeAg-positive mothers with high viral load (median, 8.4; range, 6.5-9.5 log₁₀ copies/ml), were chronically infected. After adjustment for maternal age, birth type, factors related to maternal-fetal hemorrhage, gestational age, infant gender, birth weight, timeliness of vaccination, and feeding practice, maternal viral load was significantly associated with risk of infection (adjusted odds ratio for each log₁₀ copy/ml increase, 3.49; 95% confidence interval (CI), 1.63-7.48; p=0.001). The predictive rates of infection at maternal viral load levels of 7, 8, and 9 log₁₀ copies/ml were 6.6% (95% CI, 0.5-12.6%; p=0.033), 14.6% (95% CI, 5.6-23.6%; p=0.001), and 27.7% (95% CI, 13.1-42.4%; p<0.001), respectively.

CONCLUSIONS:

Additional strategies to further reduce transmission should be considered in mothers with a viral load above 7-8 log₁₀ copies/ml.

Copyright © 2013 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

[PubMed - indexed for MEDLINE]
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