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Nguyen HT, Chaikledkaew U, Hoang MV, Tran VQ, Thavorncharoensap M, Praditsitthikorn N, Tran QD, Thakkinstian A. Economic evaluation of tenofovir disoproxil fumarate prophylaxis to prevent mother-to-child transmission of Hepatitis B virus infection: evidence from a lower-middle income country. BMC Health Serv Res 2024; 24:1658. [PMID: 39732705 DOI: 10.1186/s12913-024-12152-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2024] [Accepted: 12/20/2024] [Indexed: 12/30/2024] Open
Abstract
No cost-effectiveness information of preventive strategies for mother-to-child transmission (MTCT) of hepatitis B virus (HBV) has existed for policy decision making. This study aimed to compare the cost-effectiveness of alternative strategies to prevent MTCT of HBV in Vietnam. Cost-utility analysis using a hybrid decision-tree and Markov model were performed from healthcare system and societal perspectives. Preventive strategies included HBV universal vaccination (S1), hepatitis B immunoglobulin (HBIG) for infants of mothers with HBeAg( +) (S2), HBIG for infants of mothers with HBsAg( +) (S3), tenofovir disoproxil fumarate (TDF) for mothers with high viral load (S4) and mothers with HBeAg( +) (S5), and the current practice (S6) with HBV vaccine in all infants and TDF for high viral load mothers. The current practice was dominant to all preventive strategies with interventions in only infants for both perspectives. In contrast, the strategies S4 and S5 were dominant to the current practice with incremental net monetary benefit varying from $33.94 to $70.64 under a healthcare system perspective and from $44.22 to $93.71 under a societal perspective. Addition of HBIG in infants born to mothers infected HBV and tenofovir prophylaxis for mothers with positive HBeAg was the most cost-effective strategy to prevent vertical transmission of HBV in Vietnam.
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Affiliation(s)
- Ha T Nguyen
- Mahidol University Health Technology Assessment (MUHTA) Graduate Program, Mahidol University, Bangkok, 10400, Thailand
- University of Health Sciences, Vietnam National University Ho Chi Minh City, Binh Duong City, 820000, Vietnam
| | - Usa Chaikledkaew
- Mahidol University Health Technology Assessment (MUHTA) Graduate Program, Mahidol University, Bangkok, 10400, Thailand.
- Social and Administrative Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, 10400, Thailand.
| | - Minh V Hoang
- Hanoi University of Public Health, Hanoi, 100000, Vietnam
| | - Viet Q Tran
- Military Hospital 175, Ho Chi Minh City, Vietnam
| | - Montarat Thavorncharoensap
- Mahidol University Health Technology Assessment (MUHTA) Graduate Program, Mahidol University, Bangkok, 10400, Thailand
- Social and Administrative Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, 10400, Thailand
| | - Naiyana Praditsitthikorn
- Division of Innovation and Research, Department of Disease Control, Ministry of Public Health, Nonthaburi, 11000, Thailand
| | - Quang D Tran
- Communicable Disease Control Division, General Department of Preventive Medicine, Vietnam Ministry of Health, Hanoi, 100000, Vietnam
| | - Ammarin Thakkinstian
- Mahidol University Health Technology Assessment (MUHTA) Graduate Program, Mahidol University, Bangkok, 10400, Thailand
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
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Aliasi-Sinai L, Worthington T, Lange M, Kushner T. Maternal-to-Child Transmission of Hepatitis B Virus and Hepatitis Delta Virus. Clin Liver Dis 2023; 27:917-935. [PMID: 37778777 DOI: 10.1016/j.cld.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Maternal-to-child transmission of hepatitis B virus (HBV) and hepatitis delta virus (HDV) can lead to the risk of progressive liver disease in infants, but fortunately effective interventions exist to decrease transmission. Counseling on the risk of maternal-to-child transmission, care pathways to decrease transmission, and the implications of HBV and HDV on pregnancy outcomes are the key components of caring for pregnant people living with HBV and HDV.
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Affiliation(s)
| | - Theresa Worthington
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Marcia Lange
- Icahn School of Medicine at Mount Sinai, New York, USA
| | - Tatyana Kushner
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, USA.
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Nguyen HT, Thavorncharoensap M, Phung TL, Anothaisintawee T, Chaikledkaew U, Sobhonslidsuk A, Talungchit P, Chaiyakunapruk N, Attia J, McKay GJ, Thakkinstian A. Comparative efficacy and safety of pharmacologic interventions to prevent mother-to-child transmission of hepatitis B virus: a systematic review and network meta-analysis. Am J Obstet Gynecol 2022; 227:163-172. [PMID: 35263648 DOI: 10.1016/j.ajog.2022.02.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 02/12/2022] [Accepted: 02/23/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVE This study investigated the efficacy and safety of pharmacologic interventions to prevent vertical transmission of the hepatitis B virus. DATA SOURCES Medline, Cochrane, and Scopus databases were searched up to October 28, 2020. STUDY ELIGIBILITY CRITERIA All randomized controlled trials reporting vertical hepatitis B virus transmission with pharmacologic intervention were included. METHODS Risk of bias was assessed using the Cochrane Risk-of-Bias tool, version 2. Treatment efficacy was estimated using stratified network meta-analysis on the basis of maternal hepatitis B envelope antigen status. RESULTS Nineteen studies were included for mothers positive for hepatitis B surface and envelope antigens. Pooling indicated that a combination of hepatitis B vaccination and hepatitis B immunoglobulin in infants significantly reduced transmission risk compared with vaccination alone, with a risk ratio of 0.52 (95% confidence interval; 0.30-0.91). Only the addition of maternal tenofovir disoproxil fumarate, but not telbivudine, lamivudine, or maternal hepatitis B immunoglobulin further reduced transmission risk compared with a combination of hepatitis B vaccination and hepatitis B immunoglobulin in infants, with a pooled risk ratio of 0.10 (0.03-0.35). Twelve studies conducted in mothers with hepatitis B surface antigen positivity and mixed, unknown, or negative hepatitis B envelope antigen status provided limited evidence to suggest that maternal hepatitis B immunoglobulin combined with hepatitis B vaccination and immunoglobulin in infants was the likely best treatment, but this failed to reach statistical significance compared with a combination of hepatitis B vaccination and immunoglobulin in infants. Similarly, infant hepatitis B immunoglobulin, added to vaccination, likely provides additional benefit but failed to reach statistical significance. CONCLUSION A combination of hepatitis B vaccination and immunoglobulin in infants is the cornerstone for prevention of vertical transmission for mothers positive for both hepatitis B surface and envelope antigens. The addition of maternal tenofovir to this infant combination regimen was considered the likely most effective treatment. For infants of mothers with hepatitis B surface antigen positivity and mixed, unknown, or negative hepatitis B envelop antigen status, no additional agents provided further benefit beyond hepatitis B vaccination alone.
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Zhou Y, Lu Z, He H, Yan R, Deng X, Tang X, Zhu Y, Xu X. Influencing factors and necessity of post-vaccination serologic testing follow-up for HBsAg-positive mothers and their infants: A 5-year prospective study in Zhejiang Province, China (2016-2020). J Viral Hepat 2021; 28:1413-1421. [PMID: 34310810 DOI: 10.1111/jvh.13581] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 07/02/2021] [Accepted: 07/21/2021] [Indexed: 12/09/2022]
Abstract
In 2016, China officially proposed for the first time that infants born to HBsAg-positive mothers should be tested for HBsAg and anti-HBs 1-2 months after their third dose of HepB, also known as the post-vaccination serological testing programme. This study aimed to systematically evaluate the implementation and influencing factors of PVST to further reduce HBV infection risk in infants and improve the protective effect of HepB to the greatest extent. A prospective observational study was conducted to investigate the interruption of MTCT of hepatitis B. Univariate and multivariate analyses were applied to explore factors associated with the PVST follow-up rate among HBsAg-positive mothers and their infants. Additionally, bivariate analysis was performed on HBsAg and anti-HBs results in infants born to HBsAg-positive mothers. Here, the participation rate of PVST was 67.08% among 2120 pairs of positive mothers and infants. The HBsAg-positive rate among participants was 0.77%, whereas the anti-HBs positive rate was 96.84%, and both negative rates were 2.39%. Among infants with double negative results (34), only 15 completed three doses of HepB and PVST again, and 14 (93.33%) of which the antibody test results turned positive. Older mothers with high educational levels who reside in the local area were the most likely to PVST follow-up. The PVST programme is necessary to evaluate the HepB response status of newborns after vaccination. Moreover, revaccination for susceptible infants can effectively improve the MTCT-blocking rate of hepatitis B. Therefore, the scope of PVST projects in Zhejiang and China should be expanded.
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Affiliation(s)
- Yang Zhou
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Zhaojun Lu
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou, China
| | - Hanqing He
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Rui Yan
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Xuan Deng
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Xuewen Tang
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Yao Zhu
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Xiaoping Xu
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
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Sanghi V, Lindenmeyer CC. Viral Hepatitis in Pregnancy: An Update on Screening, Diagnosis, and Management. Clin Liver Dis (Hoboken) 2021; 18:7-13. [PMID: 34484697 PMCID: PMC8405047 DOI: 10.1002/cld.1079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 11/22/2020] [Accepted: 11/25/2020] [Indexed: 02/04/2023] Open
Affiliation(s)
- Vedha Sanghi
- Department of Digestive DiseasesUniversity of Mississippi Medical CenterJacksonMS
| | - Christina C. Lindenmeyer
- Department of Gastroenterology, Hepatology and NutritionDigestive Disease & Surgery InstituteCleveland ClinicClevelandOH
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Pan CQ, Chang TT, Bae SH, Brunetto M, Seto WK, Coffin CS, Tan SK, Mo S, Flaherty JF, Gaggar A, Nguyen MH, Çelen MK, Thompson A, Gane EJ. Antiviral kinetics of tenofovir alafenamide and tenofovir disoproxil fumarate over 24 weeks in women of childbearing potential with chronic HBV. PLoS One 2021; 16:e0251552. [PMID: 33984038 PMCID: PMC8118264 DOI: 10.1371/journal.pone.0251552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 04/25/2021] [Indexed: 12/30/2022] Open
Abstract
Background/Purpose Use of tenofovir disoproxil fumarate (TDF) improves patient outcomes in preventing mother-to-child transmission (pMTCT) of the hepatitis B virus (HBV) in mothers with chronic HBV and high viral loads. Given the lack of data for tenofovir alafenamide (TAF) in pMTCT, rates of early viral suppression with TAF and TDF were evaluated in women of childbearing potential (WOCBP) participating in 2 randomized, double-blind, Phase 3 studies in chronic HBV. Methods In a patient subset meeting WOCBP criteria and with baseline HBV DNA >200,000 IU/mL, rates of viral suppression with TAF or TDF in achieving the target of HBV DNA <200,000 IU/mL at weeks 12 and 24 were assessed. Multivariate logistic regression was used to identify factors predictive of failure to suppress HBV DNA to the target level. Results In 275 of 1298 (21%) patients meeting WOCBP criteria with high viral load, 93% and 96% had HBV DNA <200,000 IU/mL at weeks 12 and 24, respectively. Results for TAF (n = 194) vs TDF (n = 81) treatment were similar at weeks 12 and 24 (94% vs. 90% and 97% vs. 93%), respectively. High baseline HBV DNA level, genotype D infection, and prior interferon (week 24 only) were predictive of failure to achieve the target level. Both treatments were well tolerated with TAF showing less impact on renal and bone parameters. Conclusions In WOCBP with high VL, no differences were found between TAF and TDF in reducing HBV DNA to levels associated with lower transmission risk. These data support ongoing studies of TAF for pMTCT.
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Affiliation(s)
- Calvin Q. Pan
- Center for Liver Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- NYU Langone Medical Center, New York, New York, United States of America
- * E-mail:
| | | | - Si Hyun Bae
- College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | | | - Wai-Kay Seto
- Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Carla S. Coffin
- Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Susanna K. Tan
- Gilead Sciences, Inc., Foster City, California, United States of America
| | - Shuyuan Mo
- Gilead Sciences, Inc., Foster City, California, United States of America
| | - John F. Flaherty
- Gilead Sciences, Inc., Foster City, California, United States of America
| | - Anuj Gaggar
- Gilead Sciences, Inc., Foster City, California, United States of America
| | - Mindie H. Nguyen
- Stanford University, Palo Alto, California, United States of America
| | | | - Alexander Thompson
- St. Vincent’s Hospital Melbourne and The University of Melbourne, Melbourne, Australia
| | - Edward J. Gane
- New Zealand Liver Transplant Unit, Auckland Clinical Studies, Auckland, New Zealand
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Pierra Rouviere C, Dousson CB, Tavis JE. HBV replication inhibitors. Antiviral Res 2020; 179:104815. [PMID: 32380149 PMCID: PMC7293572 DOI: 10.1016/j.antiviral.2020.104815] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 04/22/2020] [Accepted: 04/28/2020] [Indexed: 12/21/2022]
Abstract
Chronic Hepatitis B Virus infections afflict >250 million people and kill nearly 1 million annually. Current non-curative therapies are dominated by nucleos(t)ide analogs (NAs) that profoundly but incompletely suppress DNA synthesis by the viral reverse transcriptase. Residual HBV replication during NA therapy contributes to maintenance of the critical nuclear reservoir of the HBV genome, the covalently-closed circular DNA, and to ongoing infection of naive cells. Identification of next-generation NAs with improved efficacy and safety profiles, often through novel prodrug approaches, is the primary thrust of ongoing efforts to improve HBV replication inhibitors. Inhibitors of the HBV ribonuclease H, the other viral enzymatic activity essential for viral genomic replication, are in preclinical development. The complexity of HBV's reverse transcription pathway offers many other potential targets. HBV's protein-priming of reverse transcription has been briefly explored as a potential target, as have the host chaperones necessary for function of the HBV reverse transcriptase. Improved inhibitors of HBV reverse transcription would reduce HBV's replication-dependent persistence mechanisms and are therefore expected to become a backbone of future curative combination anti-HBV therapies.
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Affiliation(s)
| | - Cyril B Dousson
- Ai-biopharma, Medicinal Chemistry Department, Montpellier, France.
| | - John E Tavis
- Department of Molecular Microbiology and Immunology, Saint Louis University School of Medicine, Saint Louis, MO, USA.
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