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Abstract
PURPOSE The purpose of this document is to describe the specific types of viral hepatitis, their implications during pregnancy, the risk of perinatal transmission, and issues related to both treatment and prevention of infection. TARGET POPULATION Pregnant or postpartum women and individuals who screen positive for viral hepatitis infection. The onset of these conditions may have predated the perinatal period or may have occurred for the first time in pregnancy or the first year postpartum. METHODS This guideline was developed using an a priori protocol in conjunction with a writing team consisting of one specialist in obstetrics and gynecology appointed by the ACOG Committee on Clinical Practice Guidelines-Obstetrics and one external subject matter expert. ACOG medical librarians completed a comprehensive literature search for primary literature within Cochrane Library, Cochrane Collaboration Registry of Controlled Trials, EMBASE, PubMed, and MEDLINE. Studies that moved forward to the full-text screening stage were assessed by two authors from the writing team based on standardized inclusion and exclusion criteria. Included studies underwent quality assessment, and a modified GRADE (Grading of Recommendations Assessment, Development, and Evaluation) evidence-to-decision framework was applied to interpret and translate the evidence into recommendation statements. RECOMMENDATIONS This Clinical Practice Guideline includes recommendations on hepatitis B virus and hepatitis C virus screening in pregnancy; prepregnancy, antepartum, intrapartum, and postpartum management for patients with hepatitis B virus infection or hepatitis C virus infection; management of accidental and occupational exposure to hepatitis B virus or hepatitis C virus in pregnant health care workers; and hepatitis A virus and hepatitis B virus vaccination in pregnancy. Recommendations are classified by strength and evidence quality. Ungraded Good Practice Points are included to provide guidance when a formal recommendation could not be made because of inadequate or nonexistent evidence.
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Ugwu EO, Eleje GU, Ugwu AO, Nwagha UI, Ikechebelu JI, Umeh UA, Okafor HU. Antivirals for prevention of hepatitis B virus mother-to-child transmission in human immunodeficiency virus positive pregnant women co-infected with hepatitis B virus. Cochrane Database Syst Rev 2023; 6:CD013653. [PMID: 37306558 PMCID: PMC10259198 DOI: 10.1002/14651858.cd013653.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Hepatitis B virus (HBV)-human Immunodeficiency virus (HIV) co-infection promotes an aggressive disease course of HBV infection. In the only available non-Cochrane systematic review on antiviral therapy during pregnancy for prevention of mother-to-child transmission of HBV, none of the women studied had HBV-HIV co-infection but were either HBV- or HIV-seropositive. Treatment of HBV alone may develop HIV-strains that are resistant to non-nucleoside reverse transcriptase inhibitors. Accordingly, co-treatment of the HIV infection is recommended. OBJECTIVES To evaluate the benefits and harms of tenofovir-based antiviral combination regimens versus placebo, tenofovir alone, or non-tenofovir-based antiviral regimen either alone or in combination with HBV for the prevention of mother-to-child transmission of HBV in HIV-positive pregnant women co-infected with HBV. SEARCH METHODS We searched the Cochrane Hepato-Biliary Group Controlled Trials Register, Cochrane Central Register of Controlled Trials, MEDLINE Ovid, Embase Ovid, LILACS (Bireme), Science Citation Index Expanded (Web of Science), and Conference Proceedings Citation Index-Science (Web of Science) on 30 January 2023. We manually searched the reference lists of included trials, searched on-line trial registries, and contacted experts in the field and pharmaceutical companies for any further potential trials. SELECTION CRITERIA We aimed to include randomised clinical trials comparing tenofovir-based antiviral combination regimens (anti-HIV regimen with lopinavir-ritonavir therapy, or any other antiviral therapy, and two drugs with activity against HBV, specifically, tenofovir alafenamide (TAF) or tenofovir disoproxil fumarate (TDF), plus lamivudine or emtricitabine) with placebo alone, or tenofovir alone, or non-tenofovir-based antiviral regimen (zidovudine, lamivudine, telbivudine, emtricitabine, entecavir, lopinavir-ritonavir, or any other antiviral therapy) either alone or in combination with at least two other antivirals. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Primary outcomes included all-cause infant mortality, proportion of infants with serious adverse events, proportion of infants with HBV mother-to-child transmission, all-cause maternal mortality, and proportion of mothers with serious adverse events. Secondary outcomes included proportion of infants with adverse events not considered serious, proportion of mothers with detectable HBV DNA (deoxyribonucleic acid) (before delivery), maternal hepatitis B e antigen (HBeAg) to HBe-antibody seroconversion (before delivery) and maternal adverse events not considered serious. We used RevMan Web to carry out analyses and presented results, where feasible, using a random-effects model and risk ratios (RR) with 95% confidence intervals (CIs). We performed sensitivity analysis. We assessed risk of bias using predefined domains, assessed the certainty of the evidence using GRADE, controlled risk of random errors with Trial Sequential Analysis, and presented outcome results in a summary of findings table. MAIN RESULTS Five completed trials were included, of which four trials contributed data to one or more of the outcomes. They included a total of 533 participants randomised to tenofovir-based antiviral combination regimens (196 participants) versus control (337 participants). The control groups received non-tenofovir-based antiviral regimens either as zidovudine alone (three trials) or as a combination of zidovudine, lamivudine and lopinavir-ritonavir (five trials). None of the trials used placebo or tenofovir alone. All trials were at unclear risk of bias. Four trials used intention-to-treat analyses. In the remaining trial, two participants in the intervention group and two in the control group were lost to follow-up. However, the outcomes of these four participants were not described. Tenofovir-based antiviral combination regimen versus control We are very uncertain about the effect of a tenofovir-based antiviral combination regimen versus control on all-cause infant mortality (RR 2.24, 95% CI 0.72 to 6.96; participants = 132; trials = 1; very low-certainty evidence); proportion of infants with serious adverse events (RR 1.76, 95% CI 1.27 to 2.43; participants = 132; trials = 1; very low-certainty evidence), and proportion of mothers with serious adverse events (RR 0.90, 95% CI 0.62 to 1.32; participants = 262; trials = 2; very low-certainty evidence). No trial reported data on the proportion of infants with HBV mother-to-child transmission and all-cause maternal mortality. We are also very uncertain about the effect of tenofovir-based antiviral combination regimens versus control on the proportion of infants with adverse events not considered serious (RR 0.94, 95% CI 0.06 to 13.68; participants = 31; trials = 1; very low-certainty evidence), and proportion of mothers with detectable HBV DNA (before delivery) (RR 0.66, 95% CI 0.42 to 1.02; participants = 169; trials = 2; very low-certainty evidence). No trial reported data on maternal hepatitis B e antigen (HBeAg) to HBe-antibody seroconversion (before delivery) and maternal adverse events not considered serious. All trials received support from industry. AUTHORS' CONCLUSIONS We do not know what the effects of tenofovir-based antiviral combination regimens are on all-cause infant mortality, proportion of infants with serious adverse events and proportion of mothers with serious adverse events, proportion of infants with adverse events not considered serious, and proportion of mothers with detectable HBV DNA before delivery because the certainty of evidence was very low. Only one or two trials, with insufficient power, contributed data for analyses. We lack randomised clinical trials at low risk of systematic and random errors, and fully reporting all-cause infant mortality, serious adverse events and reporting on clinical and laboratory outcomes, such as infants with HBV mother-to-child transmission, all-cause maternal mortality, maternal hepatitis B e antigen (HBeAg) to HBe-antibody seroconversion before delivery and maternal adverse events not considered serious.
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Affiliation(s)
- Emmanuel O Ugwu
- Department of Obstetrics and Gynaecology, Faculty of Medical Sciences, College of Medicine, University of Nigeria Nsukka/University of Nigeria Teaching Hospital Ituku-Ozalla, Enugu State, Enugu, Nigeria
| | - George U Eleje
- Effective Care Research Unit, Department of Obstetrics and Gynaecology, Faculty of Medicine, College of Health Sciences, Nnamdi Azikiwe University, Nnewi Campus, PMB 5001, Nnewi, Nigeria
| | - Angela O Ugwu
- Department of Haematology and Immunolology, College of Medicine, University of Nigeria Nsukka/University of Nigeria Teaching Hospital Ituku Ozalla, Enugu State, Enugu, Nigeria
| | - Uchenna I Nwagha
- Department of Haematology and Immunology, Faculty of Medical Sciences, College of Medicine, University of Nigeria Nsukka/University of Nigeria Teaching Hospital Ituku-Ozalla, Enugu State, Enugu, Nigeria
| | - Joseph I Ikechebelu
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
| | - Uchenna A Umeh
- Department of Obstetrics and Gynaecology, Faculty of Medical Science, College of Medicine, University of Nigeria Enugu Campus/University of Nigeria Teaching Hospital Ituku-Ozalla, Enugu State, Enugu, Nigeria
| | - Henrietta U Okafor
- Department of Paediatrics, Faculty of Medical Sciences, College of Medicine, University of Nigeria Enugu Campus/University of Nigeria Teaching Hospital Ituku-Ozalla, Enugu State, Enugu, Nigeria
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Lu H, Cao W, Zhang L, Yang L, Bi X, Lin Y, Deng W, Jiang T, Sun F, Zeng Z, Lu Y, Zhang L, Liu R, Gao Y, Wu S, Hao H, Chen X, Hu L, Xu M, Xiong Q, Dong J, Song R, Li M, Xie Y. Effects of hepatitis B virus infection and strategies for preventing mother-to-child transmission on maternal and fetal T-cell immunity. Front Immunol 2023; 14:1122048. [PMID: 36875136 PMCID: PMC9978148 DOI: 10.3389/fimmu.2023.1122048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 01/31/2023] [Indexed: 02/18/2023] Open
Abstract
One of the most common routes of chronic hepatitis B virus (HBV) infection is mother-to-child transmission (MTCT). Approximately 6.4 million children under the age of five have chronic HBV infections worldwide. HBV DNA high level, HBeAg positivity, placental barrier failure, and immaturity of the fetal immune are the possible causes of chronic HBV infection. The passive-active immune program for children, which consists of the hepatitis B vaccine and hepatitis B immunoglobulin, and antiviral therapy for pregnant women who have a high HBV DNA load (greater than 2 × 105 IU/ml), are currently two of the most important ways to prevent the transmission of HBV from mother to child. Unfortunately, some infants still have chronic HBV infections. Some studies have also found that some supplementation during pregnancy can increase cytokine levels and then affect the level of HBsAb in infants. For example, IL-4 can mediate the beneficial effect on infants' HBsAb levels when maternal folic acid supplementation. In addition, new research has indicated that HBV infection in the mother may also be linked to unfavorable outcomes such as gestational diabetes mellitus, intrahepatic cholestasis of pregnancy, and premature rupture of membranes. The changes in the immune environment during pregnancy and the hepatotropic nature of HBV may be the main reasons for the adverse maternal outcomes. It is interesting to note that after delivery, the women who had a chronic HBV infection may spontaneously achieve HBeAg seroconversion and HBsAg seroclearance. The maternal and fetal T-cell immunity in HBV infection is important because adaptive immune responses, especially virus-specific CD8 T-cell responses, are largely responsible for viral clearance and disease pathogenesis during HBV infection. Meanwhile, HBV humoral and T-cell responses are important for the durability of protection after fetal vaccination. This article reviews the literature on immunological characteristics of chronic HBV-infected patients during pregnancy and postpartum, blocking mother-to-child transmissions and related immune mechanisms, hoping to provide new insights for the prevention of HBV MTCT and antiviral intervention during pregnancy and postpartum.
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Affiliation(s)
- Huihui Lu
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China.,Department of Obstetrics and Gynecology, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Weihua Cao
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China.,Department of Infectious Diseases, Miyun Teaching Hospital, Capital Medical University, Beijing, China
| | - Luxue Zhang
- Infectious Disease Department, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Liu Yang
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Xiaoyue Bi
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yanjie Lin
- Department of Hepatology Division 2, Peking University Ditan Teaching Hospital, Beijing, China
| | - Wen Deng
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Tingting Jiang
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Fangfang Sun
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Zhan Zeng
- Department of Hepatology Division 2, Peking University Ditan Teaching Hospital, Beijing, China
| | - Yao Lu
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Lu Zhang
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Ruyu Liu
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yuanjiao Gao
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Shuling Wu
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Hongxiao Hao
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Xiaoxue Chen
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Leiping Hu
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Mengjiao Xu
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Qiqiu Xiong
- Department of General Surgery, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Jianping Dong
- Department of Infectious Disease, Haidian Hospital, Beijing Haidian Section of Peking University Third Hospital, Beijing, China
| | - Rui Song
- Department of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Minghui Li
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China.,Department of Hepatology Division 2, Peking University Ditan Teaching Hospital, Beijing, China
| | - Yao Xie
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China.,Department of Hepatology Division 2, Peking University Ditan Teaching Hospital, Beijing, China
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Wang S, Bai Y, Yuan F, Wang T, Luo W, Luo C, Wang Q, Wang D. Effects of hepatitis B vaccination on hepatitis B surface antigen in neonates and its change in vivo. ASIAN BIOMED 2022; 16:265-272. [PMID: 37551314 PMCID: PMC10321203 DOI: 10.2478/abm-2022-0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
Background Vaccination is effective to prevent hepatitis B virus (HBV) infection. However, there is still a risk of infection after vaccination. In clinical work, we found that newborns were positive for HBV surface antigen (HBsAg) after vaccination. Objectives To determine the effect of hepatitis B vaccination on the detection of HBsAg trend in newborns. Methods We collected data at birth, history of vaccination for hepatitis B, quantitative HBsAg results, and other information about newborns born in our hospital from July 2017 to July 2020. Serum samples from healthy neonates were randomly selected to be supplemented with recombinant hepatitis B vaccine on a concentration gradient, and HBsAg was measured quantitatively. Results Data from 1417 neonates were included in the study; 306 (21.6%) were HBsAg positive within 8 d after vaccination, with levels ranging from 0.104 IU/mL to 0.339 IU/mL. The proportion of neonates with HBsAg-positive serum was significantly correlated with the level of hepatitis B surface antibodies (anti-HBs) in the serum of their mothers (P < 0.01). Experiments in vitro showed that the proportion of neonates with HBsAg-positive serum was correlated with the dose of the hepatitis B vaccine, and when the concentration of the hepatitis B vaccine reached 5 ng/mL and 10 ng/mL, the serum HBsAg levels showed a significant negative correlation with the original concentration of serum anti-HBs. Conclusions Hepatitis B vaccination can affect the level of HBsAg detected in neonatal serum, and the effect could be mitigated by delaying the measurement. Moreover, maternal anti-HBs offset the effects of neonatal vaccination on HBsAg serum levels.
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Affiliation(s)
- Shuqi Wang
- Department of Laboratory Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan637000, China
| | - Yuting Bai
- North Sichuan Medical College, Nanchong, Sichuan637000, China
| | - Fangyuan Yuan
- North Sichuan Medical College, Nanchong, Sichuan637000, China
| | - Ting Wang
- North Sichuan Medical College, Nanchong, Sichuan637000, China
| | - Wenyi Luo
- North Sichuan Medical College, Nanchong, Sichuan637000, China
| | - Can Luo
- North Sichuan Medical College, Nanchong, Sichuan637000, China
| | - Qiang Wang
- Department of Laboratory Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan637000, China
- North Sichuan Medical College, Nanchong, Sichuan637000, China
| | - Dongsheng Wang
- Department of Clinical Laboratory, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Sichuan610041, China
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Yang N, Lei L, Meng Y, Zhou N, Shi L, Hu M. Cost-Benefit Analysis of Vaccination Strategies to Prevent Mother-to-Child Transmission of the Hepatitis B Virus Using a Markov Model Decision Tree. Front Public Health 2022; 10:662442. [PMID: 35801242 PMCID: PMC9256498 DOI: 10.3389/fpubh.2022.662442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 05/11/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives Currently, in China, several strategies exist to prevent mother-to-child transmission (MTCT) of the hepatitis B virus (HBV). These include providing Hepatitis B vaccination and hepatitis B immunoglobulin (HBIG) injection with different types of administration and dosages. The aim of this study is threefold: first, to evaluate the economic viability of current hepatitis B vaccination strategies for preventing MTCT from a public health policy perspective; second, to optimize the current immunization strategy for preventing perinatal transmission of the HBV; and third, to offer policy options to the National Health Commission in China. Methods To simulate the disease outcome for the entire life of newborns infected with HBV, a Markov model with eight possible health states was built by using TreeAge Pro 2011 software. In the present study, the model parameters were probability and cost, which were extracted from literature and calculated using Microsoft Excel 2013. The optimal immunization strategies were identified through cost-benefit analyses. A benefit-cost ratio (BCR) > 1 indicated that the strategy had positive benefits and vice versa. A one-way sensitivity analysis was used to investigate the stability of the results. Results From a public health care system perspective, we evaluated the economic viability of 11 strategies in China. For all 11 strategies, the BCR was > 1, which indicated that the benefits of all the strategies were greater than the costs. We recommended strategy number 9 as being optimal. In strategy number 9, babies born to hepatitis B surface antigen (HBsAg)-positive mothers were given an HBIG (200 IU) within 24 h of birth and three injections of hepatitis -B vaccine (20-μg each) at 0, 1, and 6 months, and the strategy had a BCR of 4.61. The one-way sensitivity analysis revealed that the full vaccination coverage and effective rates of protection were two factors that greatly influenced the BCR of the different prevention strategies; other factors had little effect. Conclusion The benefits of all strategies were greater than the costs. For decision-making and application, the strategy should be based on local socio-economic conditions so that an appropriate immunization strategy can be selected.
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Affiliation(s)
- Nan Yang
- West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Lei Lei
- West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Yiyu Meng
- West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Naitong Zhou
- West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Lizheng Shi
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Ming Hu
- West China School of Pharmacy, Sichuan University, Chengdu, China
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Tharmalingam T, Han X, Wozniak A, Saward L. Polyclonal hyper immunoglobulin: A proven treatment and prophylaxis platform for passive immunization to address existing and emerging diseases. Hum Vaccin Immunother 2022; 18:1886560. [PMID: 34010089 PMCID: PMC9090292 DOI: 10.1080/21645515.2021.1886560] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/26/2021] [Accepted: 02/01/2021] [Indexed: 12/13/2022] Open
Abstract
Passive immunization with polyclonal hyper immunoglobulin (HIG) therapy represents a proven strategy by transferring immunoglobulins to patients to confer immediate protection against a range of pathogens including infectious agents and toxins. Distinct from active immunization, the protection is passive and the immunoglobulins will clear from the system; therefore, administration of an effective dose must be maintained for prophylaxis or treatment until a natural adaptive immune response is mounted or the pathogen/agent is cleared. The current review provides an overview of this technology, key considerations to address different pathogens, and suggested improvements. The review will reflect on key learnings from development of HIGs in the response to public health threats due to Zika, influenza, and severe acute respiratory syndrome coronavirus 2.
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Affiliation(s)
- Tharmala Tharmalingam
- Therapeutics Business Unit, Emergent BioSolutions Incorporated, Winnipeg, MB, Canada
| | - Xiaobing Han
- Therapeutics Business Unit, Emergent BioSolutions Incorporated, Winnipeg, MB, Canada
- Department of Immunology, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Ashley Wozniak
- Therapeutics Business Unit, Emergent BioSolutions Incorporated, Winnipeg, MB, Canada
| | - Laura Saward
- Therapeutics Business Unit, Emergent BioSolutions Incorporated, Winnipeg, MB, Canada
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
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Mao L, Zhu AK, Liu J. Correlation between postpartum unsatisfied needs of hepatitis B virus carriers and childcare competence. Shijie Huaren Xiaohua Zazhi 2021; 29:1434-1440. [DOI: 10.11569/wcjd.v29.i24.1434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hepatitis B virus (HBV) carriers have special characteristics due to the illness and their psychological, physiological, and social needs, often accompanied by negative psychology such as anxiety and self-accusation. Hostile handling or avoidance coping style is not conducive to the transformation of their mother's role, and it is difficult to meet their emotional needs and childcare needs. Therefore, the childcare competence is low. It is particularly important to formulate relevant measures to improve maternal childcare competence.
AIM To analyze the correlation between the postpartum unsatisfied needs of HBV carriers and the parenting competence, and explore the related factors that affect the parenting competence.
METHODS In this study, 95 HBV carriers who delivered at our hospital from June 2019 to March 2021 were selected using the convenience sampling method in this cross-sectional survey. The general information of the subjects was collected via a survey form. The Short-Form Survivor Unmet Needs Survey (SF-SUNS) and Chinese Version Parenting Sense Competence Scale (C-PSOC) were used to analyze the correlation between unmet needs and childcare competence, and multivariate hierarchical regression analysis was used to analyze the factors affecting the childcare competence of pregnant HBV carriers.
RESULTS Ninety-five questionnaires were issued, and 90 valid questionnaires were returned. The valid response rate was 94.74%. The total score of the SF-SUNS scale for the 90 HBV carriers was 73.54 ± 12.75, and the total score of the C-PSOC scale was 68.66 ± 8.12. Pearson correlation analysis showed that the total score and the scores of each dimension of the SF-SUNS scale for pregnant HBV carriers were negatively correlated with the total score and the scores of each dimension of the C-PSOC scale (r < 0, P < 0.05). Hierarchical regression analysis showed that education level, parenting knowledge, previous parenting experience, participation in infant care work, postpartum depression, and social support were factors influencing maternal competence in parenting in HBV carriers (P < 0.05). After controlling for general demographic data, the total score and scores of all dimensions of the SF-SUNS scale were influencing factors on the competence of pregnant HBV carriers (P < 0.05).
CONCLUSION There are moderate postpartum unmet needs of HBV carriers and childcare competency, and the two are negatively correlated. Medical staff should pay attention to assessing the unmet needs of HBV carriers after delivery and improving their parenting knowledge, social support, and psychological status to improve maternal and child-raising competency.
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Affiliation(s)
- Liang Mao
- Department of Obstetrics and Gynecology, Yuyao Maternal and Child Health Care Hospital, Yuyao 315400, Zhejiang Province, China
| | - A-Kao Zhu
- Department of Gastrointestinal Surgery, Hangzhou First People's Hospital, Hangzhou 310000, Zhejiang Province, China
| | - Jia Liu
- Department of Obstetrics and Gynecology, Yuyao Maternal and Child Health Care Hospital, Yuyao 315400, Zhejiang Province, China
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Lin Y, Liu Y, Xu D, Guo F, Zhang W, Zhang Y, Bai G. HBxAg promotes HBV replication and EGFR activation in human placental trophoblasts. Exp Ther Med 2021; 22:1211. [PMID: 34584556 PMCID: PMC8422389 DOI: 10.3892/etm.2021.10645] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 06/09/2021] [Indexed: 12/14/2022] Open
Abstract
Hepatitis B virus (HBV) infection is a global epidemic. The main transmission route of chronic HBV infection is from mother to child, yet the mechanisms underlying HBV intrauterine infection remain unclear. In the present study, the effect and the mechanism underlying hepatitis B virus X antigen (HBxAg) on HBV replication and EGFR activation in trophoblasts was investigated. Serum samples from pregnant women with HBV infection were used to infect trophoblasts and HBxAg expression was detected using ELISA. HBV plasmids carrying either full length hepatitis B virus X (HBx) or HBx with a deletion mutation (ΔHBx) were transfected into trophoblasts and expression levels of HBV DNA, hepatitis B e-antigen and pregenomic (pg)RNA, and structural maintenance of chromosomes (Smc) 5/6 were assessed. The association between HBx and EGFR promoters was characterized using a luciferase reporter assay and EGFR/PI3K/phosphorylated (p)-AKT expression and apoptosis rate were also monitored. The results of the present study indicated that HBxAg expression increased with the increasing titre of HBV DNA (P<0.05). Compared with the wild-type group, the amount of HBV DNA in the supernatant and cells was significantly reduced (P<0.05) in the ΔHBx group and the intracellular HBeAg and pgRNA levels were also significantly decreased (P<0.05). In addition, Smc5/6 expression was also significantly decreased (P<0.05) when the intracellular HBx protein was expressed compared with mock-transfected cells. Co-transfection of HBx and EGFR promoter plasmids in JEG-3 and HTR-8 cells significantly elevated EGFR promoter driven luciferase expression relative to the control group (P<0.01). In EGFR overexpressing cells, the expression of PI3K/p-AKT was significantly increased, whereas the apoptosis rate was significantly decreased (P<0.05). These results were reversed in the EGFR-knockdown group. In conclusion, the present study demonstrated that HBx promotes HBV replication in trophoblasts via downregulation of Smc5/6, activates the EGFR promoter and inhibits trophoblast apoptosis via the PI3K/p-AKT downstream signalling pathway, thereby increasing the risk of HBV intrauterine infection.
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Affiliation(s)
- Yayun Lin
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Yan Liu
- Institute of Infectious Diseases, 5th Medical Center of Chinese PLA General Hospital, Beijing 100141, P.R. China
| | - Dongping Xu
- Institute of Infectious Diseases, 5th Medical Center of Chinese PLA General Hospital, Beijing 100141, P.R. China
| | - Fanfan Guo
- College of Medicine, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Wentao Zhang
- College of Medicine, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Yidan Zhang
- College of Medicine, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Guiqin Bai
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
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Eleje GU, Akaba GO, Mbachu II, Rabiu A, Loto OM, Usman HA, Fiebai PO, Chukwuanukwu RC, Joe-Ikechebelu NN, Nwankwo CH, Kalu SO, Onubogu CU, Ogbuagu CN, Chukwurah SN, Uzochukwu CE, Inuyomi SO, Adesoji BA, Ogwaluonye UC, Nweje SI, Egeonu RO, Igue OE, Jibuaku CH, Aja PO, Chidozie CP, Ibrahim HS, Aliyu FE, Numan AI, Okoro OD, Omoruyi SA, Oppah IC, Anyang UI, Ahmed A, Umeononihu OS, Umeh EO, Emeka EA, Onwuegbuna AA, Igbodike EP, Ajuba IC, Yakasai IA, Ezechi OC, Ikechebelu JI. Pregnant women's hepatitis B vaccination coverage in Nigeria: a national pilot cross-sectional study. Ther Adv Vaccines Immunother 2021; 9:25151355211032595. [PMID: 34377929 PMCID: PMC8327013 DOI: 10.1177/25151355211032595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 06/18/2021] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE To determine the hepatitis B vaccination coverage, full-dose (⩾3) coverage and the associated factors affecting uptake among pregnant women. METHODS This was a cross-sectional study among pregnant women attending antenatal care in six tertiary hospitals across all the geopolitical zones of Nigeria. Pregnant women who consented to the study completed screening questions about their hepatitis B vaccination status and coverage. The main outcome measures were hepatitis B vaccination coverage rate, dose, and factors affecting uptake. Bivariate analysis was performed by the chi-square test and conditional logistic regression analysis was used to determine variables associated with uptake of the vaccination. Odds ratios (ORs) and adjusted odds ratios (aORs) were calculated and statistical significance was accepted when p-value was < 0.05. RESULTS Of 159 pregnant women who completed the interview questions, 21 [13.2%, 95% confidence interval (CI) 7.9-18.5%] were vaccinated for hepatitis B for one to three doses. The numbers of doses received were: three doses (8/159, 5.0%), two doses (5/159, 3.1%), and one dose (8/159, 5.0%). The reasons for non-uptake of vaccination included: lack of awareness of the vaccine 83/138 (60.1%), inadequate access to vaccine 11/138 (8.0%), and positivity to hepatitis B virus 10/138 (7.2%). The uptake of hepatitis B vaccination was significantly affected by the level of education (OR 0.284, 95% CI 0.08-1.01, p = 0.041), but in multivariable logistic regression, adjusted for confounders, the association between hepatitis B vaccination and participants' level of education (aOR 3.09; 95% CI 0.95-10.16; p = 0.061) did not remain significant. CONCLUSIONS In Nigeria, the national hepatitis B vaccination coverage among pregnant women appears poor, with the full-dose coverage even poorer. The level of education was not positively associated with uptake of hepatitis B vaccination, while lack of awareness of the vaccine was the commonest reason for non-uptake. FUNDING TETFund National Research Fund 2019 (grant number TETFund/DR&D/CE/NRF/STI/33).
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Affiliation(s)
- George Uchenna Eleje
- Effective Care Research Unit, Department of
Obstetrics and Gynecology, Faculty of Medicine, Nnamdi Azikiwe University,
Awka, Nigeria
- Department of Obstetrics and Gynecology, Nnamdi
Azikiwe University Teaching Hospital, Number 49 Nnewi Onitsha Road, 435001,
Nnewi, Anambra State, Nigeria
| | - Godwin Otuodichinma Akaba
- Department of Obstetrics and Gynecology,
University of Abuja, Abuja, Nigeria
- Department of Obstetrics and Gynecology,
University of Abuja Teaching Hospital, Abuja, Nigeria
| | - Ikechukwu Innocent Mbachu
- Department of Obstetrics and Gynecology, Nnamdi
Azikiwe University, Awka, Nigeria
- Department of Obstetrics and Gynecology, Nnamdi
Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Ayyuba Rabiu
- Department of Obstetrics and Gynecology, Bayero
University, Kano, Nigeria
- Department of Obstetrics and Gynecology, Aminu
Kano Teaching Hospital, Kano, Nigeria
| | - Olabisi Morebise Loto
- Department of Obstetrics and Gynecology,
Obafemi Awolowo University, Ile-Ife, Nigeria
- Department of Obstetrics and Gynecology,
Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria
| | - Hadiza Abdullahi Usman
- Department of Obstetrics and Gynecology,
University of Maiduguri, Maiduguri, Nigeria
- Department of Obstetrics and Gynecology,
University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
| | - Preye Owen Fiebai
- Department of Obstetrics and Gynecology,
University of Port Harcourt, Port Harcourt, Nigeria
- Department of Obstetrics and Gynecology,
University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | | | - Ngozi Nneka Joe-Ikechebelu
- Department of Community Medicine, Chukwuemeka
Odumegwu Ojukwu University Teaching Hospital, Awka, Nigeria
| | | | - Stephen Okoroafor Kalu
- HIV Care Laboratory/HIV Care Department,
Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
| | | | | | - Shirley Nneka Chukwurah
- Gastroenterology Unit, Department of Medicine,
Faculty of Medicine, Nnamdi Azikiwe University, Awka, Nigeria
| | | | | | - Bukola Abimbola Adesoji
- Department of Nursing, Obafemi Awolowo
University Teaching Hospital Complex, Ile-Ife, Nigeria
| | | | | | - Richard Obinwanne Egeonu
- Department of Obstetrics and Gynecology,
Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State,
Nigeria
| | - Odion Emmanuel Igue
- Department of Physiological Sciences, Obafemi
Awolowo University, Ile-Ife, Nigeria
| | | | - Prince Ogbonnia Aja
- Immunology Unit, Department of Medical
Laboratory Science, Nnamdi Azikiwe University, Awka, Nigeria
| | | | - Hadiza Sani Ibrahim
- Department of Obstetrics and Gynecology, Aminu
Kano Teaching Hospital, Kano, Nigeria
| | - Fatima Ele Aliyu
- Department of Obstetrics and Gynecology, Aminu
Kano Teaching Hospital, Kano, Nigeria
| | - Aisha Ismaila Numan
- Department of Obstetrics and Gynecology,
University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
| | - Ogbonna Dennis Okoro
- Department of Parasitology & Entomology,
Faculty of Veterinary Medicine, University of Maiduguri, Maiduguri, Borno
State, Nigeria
| | - Solace Amechi Omoruyi
- Department of Obstetrics and Gynecology,
University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - Ijeoma Chioma Oppah
- Department of Obstetrics and Gynecology,
University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - Ubong Inyang Anyang
- Department of Obstetrics and Gynecology,
University of Abuja Teaching Hospital, Abuja, Nigeria
| | - Aishat Ahmed
- Department of Obstetrics and Gynecology,
University of Abuja Teaching Hospital, Abuja, Nigeria
| | - Osita Samuel Umeononihu
- Department of Obstetrics and Gynecology,
Nnamdi Azikiwe University, Awka, Nigeria
- Department of Obstetrics and Gynecology,
Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State,
Nigeria
| | - Eric Okechukwu Umeh
- Department of Radiology, Faculty of Medicine,
Nnamdi Azikiwe University, Awka, Nigeria
| | - Ekene Agatha Emeka
- Department of Family Medicine, Faculty of
Medicine, Nnamdi Azikiwe University, Awka, Nigeria
| | | | - Emeka Philip Igbodike
- Department of Obstetrics and Gynecology, St
Georges Hospital Memorial Centre, Lagos, Nigeria
| | - Ifeoma Clara Ajuba
- Department of Hematology, Faculty of Medicine,
Nnamdi Azikiwe University, Awka, Nigeria
| | - Ibrahim Adamu Yakasai
- Department of Obstetrics and Gynecology,
Bayero University, Kano, Nigeria
- Department of Obstetrics and Gynecology, Aminu
Kano Teaching Hospital, Kano, Nigeria
| | | | - Joseph Ifeanyichukwu Ikechebelu
- Department of Obstetrics and Gynecology,
Nnamdi Azikiwe University, Awka, Nigeria
- Department of Obstetrics and Gynecology,
Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State,
Nigeria
| | - Triplex Infection in Pregnancy Collaboration Group
- Department of Obstetrics and Gynecology,
Nnamdi Azikiwe University, Awka, Nigeria
- Department of Obstetrics and Gynecology,
Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State,
Nigeria
- Department of Obstetrics and Gynecology,
University of Abuja, Abuja, Nigeria
- Department of Obstetrics and Gynecology,
University of Abuja Teaching Hospital, Abuja, Nigeria
- Department of Obstetrics and Gynecology,
Bayero University, Kano, Nigeria
- Department of Obstetrics and Gynecology, Aminu
Kano Teaching Hospital, Kano, Nigeria
- Department of Obstetrics and Gynecology,
Obafemi Awolowo University, Ile-Ife, Nigeria
- Department of Obstetrics and Gynecology,
Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria
- Department of Obstetrics and Gynecology,
University of Maiduguri, Maiduguri, Nigeria
- Department of Obstetrics and Gynecology,
University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
- Department of Obstetrics and Gynecology,
University of Port Harcourt, Port Harcourt, Nigeria
- Department of Obstetrics and Gynecology,
University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
- Immunology Unit, Department of Medical
Laboratory Science, Nnamdi Azikiwe University, Awka, Nigeria
- Department of Community Medicine, Chukwuemeka
Odumegwu Ojukwu University Teaching Hospital, Awka, Nigeria
- Department of Statistics, Nnamdi Azikiwe
University, Awka, Nigeria
- HIV Care Laboratory/HIV Care Department,
Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
- Department of Paediatrics, Nnamdi Azikiwe
University, Awka, Nigeria
- Department of Medical Microbiology and
Parasitology, Faculty of Medicine, Nnamdi Azikiwe University, Awka,
Nigeria
- Gastroenterology Unit, Department of Medicine,
Faculty of Medicine, Nnamdi Azikiwe University, Awka, Nigeria
- Department of Mass Communication, Nnamdi
Azikiwe University, Awka, Nigeria
- Department of Physics and Engineering Physics,
Obafemi Awolowo University, Ile-Ife, Nigeria
- Department of Nursing, Obafemi Awolowo
University Teaching Hospital Complex, Ile-Ife, Nigeria
- Department of Pharmaceutical Sciences, Nnamdi
Azikiwe University, Awka, Nigeria
- Department of Nursing, Nnamdi Azikiwe
University Teaching Hospital, Nnewi, Nigeria
- Department of Physiological Sciences, Obafemi
Awolowo University, Ile-Ife, Nigeria
- Department of Parasitology & Entomology,
Faculty of Veterinary Medicine, University of Maiduguri, Maiduguri, Borno
State, Nigeria
- Department of Radiology, Faculty of Medicine,
Nnamdi Azikiwe University, Awka, Nigeria
- Department of Family Medicine, Faculty of
Medicine, Nnamdi Azikiwe University, Awka, Nigeria
- Department of Ophthalmology, Nnamdi Azikiwe
University, Awka, Nigeria
- Department of Obstetrics and Gynecology, St
Georges Hospital Memorial Centre, Lagos, Nigeria
- Department of Hematology, Faculty of Medicine,
Nnamdi Azikiwe University, Awka, Nigeria
- Nigerian Institute of Medical Research, Lagos,
Nigeria
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10
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Veronese P, Dodi I, Esposito S, Indolfi G. Prevention of vertical transmission of hepatitis B virus infection. World J Gastroenterol 2021; 27:4182-4193. [PMID: 34326618 PMCID: PMC8311536 DOI: 10.3748/wjg.v27.i26.4182] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/29/2021] [Accepted: 06/02/2021] [Indexed: 02/06/2023] Open
Abstract
Hepatitis B virus (HBV) is the leading cause of chronic viral hepatitis. Annually, almost two million children younger than 5 years acquire the infection, mostly through vertical or horizontal transmission in early life. Vertical transmission of HBV is a high efficacy phenomenon ranging, in the absence of any preventive interventions, from 70% to 90% for hepatitis e antigen positive mothers and from 10% to 40% for hepatitis e antigen-negative mothers. Maternal viraemia is a preeminent risk factor for vertical transmission of HBV. Maternal screening is the first step to prevent vertical transmission of HBV. Hepatitis B passive and active immunoprophylaxis at birth together with antiviral treatment of highly viraemic mothers are the key strategies for global elimination of HBV infection. Strategies are needed to promote implementation of birth-dose vaccination and hepatitis B immunoglobulins in low- and middle-income countries where the prevalence of the infection is at the highest.
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Affiliation(s)
- Piero Veronese
- Department of Medicine and Surgery, University of Parma, Parma 43121, Italy
| | - Icilio Dodi
- Department of Pediatrics, Pietro Barilla Children's Hospital, Parma 43121, Italy
| | - Susanna Esposito
- Department of Medicine and Surgery, University of Parma, Parma 43121, Italy
| | - Giuseppe Indolfi
- Department Neurofarba, University of Florence, Florence 50129, Italy
- Department Neurofarba, Meyer Children's University Hospital, Florence 50129, Italy
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11
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Hong J, Choi Y, Choi Y, Lee J, Hong HJ. Epitope-Paratope Interaction of a Neutralizing Human Anti-Hepatitis B Virus PreS1 Antibody That Recognizes the Receptor-Binding Motif. Vaccines (Basel) 2021; 9:vaccines9070754. [PMID: 34358170 PMCID: PMC8310169 DOI: 10.3390/vaccines9070754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/25/2021] [Accepted: 06/29/2021] [Indexed: 11/16/2022] Open
Abstract
Hepatitis B virus (HBV) is a global health burden that causes acute and chronic hepatitis. To develop an HBV-neutralizing antibody that effectively prevents HBV infection, we previously generated a human anti-preS1 monoclonal antibody (1A8) that binds to genotypes A–D and validated its HBV-neutralizing activity in vitro. In the present study, we aimed to determine the fine epitope and paratope of 1A8 to understand the mechanism of HBV neutralization. We performed alanine-scanning mutagenesis on the preS1 (aa 19–34, genotype C) and the heavy (HCDR) and light (LCDR) chain complementarity-determining regions. The 1A8 recognized the three residues (Leu22, Gly23, and Phe25) within the highly conserved receptor-binding motif (NPLGFFP) of the preS1, while four CDR residues of 1A8 were critical in antigen binding. Structural analysis of the epitope–paratope interaction by molecular modeling revealed that Leu100 in the HCDR3, Ala50 in the HCDR2, and Tyr96 in the LCDR3 closely interacted with Leu22, Gly23, and Phe25 of the preS1. Additionally, we found that 1A8 also binds to the receptor-binding motif (NPLGFLP) of infrequently occurring HBV. The results suggest that 1A8 may broadly and effectively block HBV entry and thus have potential as a promising candidate for the prevention and treatment of HBV infection.
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Affiliation(s)
- Jisu Hong
- Department of Systems Immunology, College of Biomedical Science, Kangwon National University, Chuncheon 24341, Korea; (J.H.); (Y.C.); (J.L.)
| | - Youngjin Choi
- Department of Systems Immunology, College of Biomedical Science, Kangwon National University, Chuncheon 24341, Korea; (J.H.); (Y.C.); (J.L.)
| | - Yoonjoo Choi
- Medical Research Center, Chonnam National University Medical School, Hwasun 58128, Korea;
| | - Jiwoo Lee
- Department of Systems Immunology, College of Biomedical Science, Kangwon National University, Chuncheon 24341, Korea; (J.H.); (Y.C.); (J.L.)
| | - Hyo Jeong Hong
- Department of Systems Immunology, College of Biomedical Science, Kangwon National University, Chuncheon 24341, Korea; (J.H.); (Y.C.); (J.L.)
- Correspondence: ; Tel.: +82-33-250-8381; Fax: +82-33-259-5643
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12
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Narang K, Cheek EH, Enninga EAL, Theiler RN. Placental Immune Responses to Viruses: Molecular and Histo-Pathologic Perspectives. Int J Mol Sci 2021; 22:2921. [PMID: 33805739 PMCID: PMC7998619 DOI: 10.3390/ijms22062921] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/09/2021] [Accepted: 03/09/2021] [Indexed: 12/12/2022] Open
Abstract
As most recently demonstrated by the SARS-CoV-2 pandemic, congenital and perinatal infections are of significant concern to the pregnant population as compared to the general population. These outcomes can range from no apparent impact all the way to spontaneous abortion or fetal infection with long term developmental consequences. While some pathogens have developed mechanisms to cross the placenta and directly infect the fetus, other pathogens lead to an upregulation in maternal or placental inflammation that can indirectly cause harm. The placenta is a temporary, yet critical organ that serves multiple important functions during gestation including facilitation of fetal nutrition, oxygenation, and prevention of fetal infection in utero. Here, we review trophoblast cell immunology and the molecular mechanisms utilized to protect the fetus from infection. Lastly, we discuss consequences in the placenta when these protections fail and the histopathologic result following infection.
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Affiliation(s)
- Kavita Narang
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA;
| | - Elizabeth H. Cheek
- Department of Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA;
| | - Elizabeth Ann L. Enninga
- Departments of Immunology, Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA;
| | - Regan N. Theiler
- Division of Obstetrics, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA
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13
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Eleje GU, Mbachu II, Ogwaluonye UC, Kalu SO, Onubogu CU, Nweje SI, Uzochukwu CE, Nwankwo CH, Fiebai PO, Loto OM, Akaba GO, Usman HA, Rabiu A, Egeonu RO, Igue OE, Adesoji BA, Jibuaku CH, Aja PO, Chidozie CP, Ibrahim HS, Aliyu FE, Numan AI, Okoro OD, Omoruyi SA, Oppah IC, Anyang UI, Ahmed A, Chukwurah SN, Umeononihu OS, Chukwuanukwu RC, Umeh EO, Emeka EA, Ogbuagu CN, Yakasai IA, Ezechi OC, Ikechebelu JI. Prevalence, seroconversion and mother-to-child transmission of dual and triplex infections of HIV, hepatitis B and C viruses among pregnant women in Nigeria: study protocol. Reprod Health 2020; 17:144. [PMID: 32977846 PMCID: PMC7519506 DOI: 10.1186/s12978-020-00995-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 09/16/2020] [Indexed: 12/16/2022] Open
Abstract
Background Nigeria contributes significantly to the global burden of HIV, Hepatitis B and C infections, either singly or in combinations, despite progress in HIV care regionally and globally. Although some limited data on mono infection of HIV, Hepatitis B and C virus infections do exists, that of dual and triplex infections, including seroconversion and mother-to-child transmission (MTCT) rates necessary for planning to address the scourge of infections in pregnancy are not available. Objectives To determine the seroprevalence, rate of new infections, MTCT of dual and triple infections of HIV, Hepatitis B and C viruses and associated factors, among pregnant women in Nigeria. Method A multicenter prospective cohort study will be conducted in six tertiary health facilities randomly selected from the six geopolitical zones of Nigeria. All eligible pregnant women are to be tested at enrollment after informed consent for HIV, Hepatitis B and C virus infections. While those positive for at least two of the infections in any combination will be enrolled into the study and followed up to 6 weeks post-delivery, those negative for the three infections or positive for only one of the infections at enrolment will be retested at delivery using a rapid diagnostic test. On enrolment into the study relevant information, will be obtained, and laboratory test of CD4 count, liver function test and full blood counts, and prenatal ultrasonography will also be obtained/performed. Management of mother-newborns pairs will be according to appropriate national guidelines. All exposed newborns will be tested for HIV, HBV or HCV infection at birth and 6 weeks using PCR technique. The study data will be documented on the study case record forms. Data will be managed with SPSS for windows version 23. Ethical approval was obtained from National Health Research Ethics Committee (NHREC) (NHREC/01/01/2007–23/01/2020). Conclusion Pregnant women with multiple of HIV, HBV and HCV infections are at increased risk of hepatotoxicity, maternal and perinatal morbidity and mortality. Additionally, infected pregnant women transmit the virus to their unborn baby even when asymptomatic. Children born with any of the infection have significantly poorer quality of life and lower five-year survival rate. Unfortunately, the seroconversion and MTCT rates of dual or triplex infections among pregnant women in Nigeria have not been studied making planning for prevention and subsequent elimination of the viruses difficult. The study is expected to fill this knowledge gaps. Nigeria joining the rest of the world to eliminate the triple infection among children rest on the availability of adequate and reliable data generated from appropriately designed, and powered study using representative population sample. The establishment of the three-in-one study of prevalence, rate of new infection, rate and risk factor for MTCT of dual and triple infection of HIV, Hepatitis B and C viruses among pregnant women in Nigeria is urgently needed for policy development and planning for the improvement of the quality of life of mothers and the elimination of childhood triplex infection.
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Affiliation(s)
- George Uchenna Eleje
- Department of Obstetrics and Gynecology, Nnamdi Azikiwe University, Awka, Nigeria. .,Department of Obstetrics and Gynecology, Nnamdi Azikiwe University Teaching Hospital, PMB 5025, Nnewi, Anambra State, Nigeria.
| | - Ikechukwu Innocent Mbachu
- Department of Obstetrics and Gynecology, Nnamdi Azikiwe University, Awka, Nigeria.,Department of Obstetrics and Gynecology, Nnamdi Azikiwe University Teaching Hospital, PMB 5025, Nnewi, Anambra State, Nigeria
| | | | - Stephen Okoroafor Kalu
- HIV Care Laboratory/HIV Care Department, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
| | | | | | | | | | - Preye Owen Fiebai
- Department of Obstetrics and Gynecology, University of Port Harcourt, PortHarcourt, Nigeria.,Department of Obstetrics and Gynecology, University of Port Harcourt Teaching Hospital, PortHarcourt, Nigeria
| | - Olabisi Morebise Loto
- Department of Obstetrics and Gynecology, Obafemi Awolowo University, Ile Ife, Nigeria.,Department of Obstetrics and Gynecology, Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria
| | - Godwin Otuodichinma Akaba
- Department of Obstetrics and Gynecology, University of Abuja, Abuja, Nigeria.,Department of Obstetrics and Gynecology, University of Abuja Teaching Hospital, Abuja, Nigeria
| | - Hadiza Abdullahi Usman
- Department of Obstetrics and Gynecology, University of Maiduguri, Maiduguri, Nigeria.,Department of Obstetrics and Gynecology, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
| | - Ayyuba Rabiu
- Department of Obstetrics and Gynecology, Bayero University, Kano, Nigeria.,Department of Obstetrics and Gynecology, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Richard Obinwanne Egeonu
- Department of Obstetrics and Gynecology, Nnamdi Azikiwe University Teaching Hospital, PMB 5025, Nnewi, Anambra State, Nigeria
| | - Odion Emmanuel Igue
- Department of Physiological Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Bukola Abimbola Adesoji
- Department of Nursing, Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria
| | | | - Prince Ogbonnia Aja
- Immunology Unit, Department of Medical Laboratory Science, Nnamdi Azikiwe University, Awka, Nigeria
| | | | - Hadiza Sani Ibrahim
- Department of Obstetrics and Gynecology, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Fatima Ele Aliyu
- Department of Obstetrics and Gynecology, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Aisha Ismaila Numan
- Department of Obstetrics and Gynecology, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
| | - Ogbonna Dennis Okoro
- Department of Parasitology & Entomology, Faculty of Veterinary Medicine, University of Maiduguri Borno State, Maiduguri, Nigeria
| | - Solace Amechi Omoruyi
- Department of Obstetrics and Gynecology, University of Port Harcourt Teaching Hospital, PortHarcourt, Nigeria
| | - Ijeoma Chioma Oppah
- Department of Obstetrics and Gynecology, University of Port Harcourt Teaching Hospital, PortHarcourt, Nigeria
| | - Ubong Inyang Anyang
- Department of Obstetrics and Gynecology, University of Abuja Teaching Hospital, Abuja, Nigeria
| | - Aishat Ahmed
- Department of Obstetrics and Gynecology, University of Abuja Teaching Hospital, Abuja, Nigeria
| | | | - Osita Samuel Umeononihu
- Department of Obstetrics and Gynecology, Nnamdi Azikiwe University, Awka, Nigeria.,Department of Obstetrics and Gynecology, Nnamdi Azikiwe University Teaching Hospital, PMB 5025, Nnewi, Anambra State, Nigeria
| | | | - Eric Okechukwu Umeh
- Department of Radiology, Faculty of Medicine, Nnamdi Azikiwe University, Awka, Nigeria
| | - Ekene Agatha Emeka
- Department of Family Medicine, Faculty of Medicine, Nnamdi Azikiwe University, Awka, Nigeria
| | | | - Ibrahim Adamu Yakasai
- Department of Obstetrics and Gynecology, Bayero University, Kano, Nigeria.,Department of Obstetrics and Gynecology, Aminu Kano Teaching Hospital, Kano, Nigeria
| | | | - Joseph Ifeanyichukwu Ikechebelu
- Department of Obstetrics and Gynecology, Nnamdi Azikiwe University, Awka, Nigeria.,Department of Obstetrics and Gynecology, Nnamdi Azikiwe University Teaching Hospital, PMB 5025, Nnewi, Anambra State, Nigeria
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14
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Ugwu EO, Eleje GU, Ugwu AO, Nwagha UI, Ikechebelu JI, Umeh UA, Okafor HU. Antivirals for prevention of hepatitis B virus mother-to-child transmission in human immunodeficiency virus positive pregnant women co-infected with hepatitis B virus. Hippokratia 2020. [DOI: 10.1002/14651858.cd013653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Emmanuel O Ugwu
- Obstetrics and Gynaecology; University of Nigeria Enugu Campus/University of Nigeria Teaching Hospital Ituko-Ozalla; Enugu Nigeria
| | - George U Eleje
- Effective Care Research Unit, Department of Obstetrics and Gynaecology; Faculty of Medicine, College of Health Sciences, Nnamdi Azikiwe University, Nnewi Campus; PMB 5001, Nnewi Nigeria
| | - Angela O Ugwu
- Haematology and Immunolology; University of Nigeria Nsukka/University of Nigeria Teaching Hospital Ituku Ozalla; Enugu Nigeria
| | - Uchenna I Nwagha
- Department of Obstetrics and Gynaecology, Faculty of Medicine; University of Nigeria Enugu Campus/University of Nigeria Teaching Hospital Ituko-Ozalla; Enugu Nigeria
| | - Joseph I Ikechebelu
- Department of Obstetrics/Gynaecology; Nnamdi Azikiwe University Teaching Hospital; Nnewi Nigeria
| | - Uchenna A Umeh
- Department of Obstetrics and Gynaecology, Faculty of Medical Science; College of Medicine, University of Nigeria Enugu Campus/University of Nigeria Teaching Hospital Ituku-Ozalla; Enugu Nigeria
| | - Henrietta U Okafor
- Department of Paediatrics; Faculty of Medical Sciences, College of Medicine, University of Nigeria Enugu Campus/University of Nigeria Teaching Hospital Ituku-Ozalla; Enugu Nigeria
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15
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Abstract
Hepatitis B virus (HBV), an enveloped partially double-stranded DNA virus, is a widespread human pathogen responsible for more than 250 million chronic infections worldwide. Current therapeutic strategies cannot eradicate HBV due to the persistence of the viral genome in a special DNA structure (covalently closed circular DNA, cccDNA). The identification of sodium taurocholate co-transporting polypeptide (NTCP) as an entry receptor for both HBV and its satellite virus hepatitis delta virus (HDV) has led to great advances in our understanding of the life cycle of HBV, including the early steps of infection in particular. However, the mechanisms of HBV internalization and the host factors involved in this uptake remain unclear. Improvements in our understanding of HBV entry would facilitate the design of new therapeutic approaches targeting this stage and preventing the de novo infection of naïve hepatocytes. In this review, we provide an overview of current knowledge about the process of HBV internalization into cells.
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Affiliation(s)
- Charline Herrscher
- Inserm U1259, Morphogénèse et Antigénicité du VIH et des Virus des Hépatites (MAVIVH), Université de Tours and CHRU de Tours, 37032 Tours, France;
| | - Philippe Roingeard
- Inserm U1259, Morphogénèse et Antigénicité du VIH et des Virus des Hépatites (MAVIVH), Université de Tours and CHRU de Tours, 37032 Tours, France;
- Plate-Forme IBiSA des Microscopies, PPF ASB, Université de Tours and CHRU de Tours, 37032 Tours, France
- Correspondence: (P.R.); (E.B.); Tel.: +33-2-3437-9646 (E.B.)
| | - Emmanuelle Blanchard
- Inserm U1259, Morphogénèse et Antigénicité du VIH et des Virus des Hépatites (MAVIVH), Université de Tours and CHRU de Tours, 37032 Tours, France;
- Plate-Forme IBiSA des Microscopies, PPF ASB, Université de Tours and CHRU de Tours, 37032 Tours, France
- Correspondence: (P.R.); (E.B.); Tel.: +33-2-3437-9646 (E.B.)
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16
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Yang JD, Hainaut P, Gores GJ, Amadou A, Plymoth A, Roberts LR. A global view of hepatocellular carcinoma: trends, risk, prevention and management. Nat Rev Gastroenterol Hepatol 2019; 16:589-604. [PMID: 31439937 PMCID: PMC6813818 DOI: 10.1038/s41575-019-0186-y] [Citation(s) in RCA: 2195] [Impact Index Per Article: 439.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/04/2019] [Indexed: 02/06/2023]
Abstract
Hepatocellular carcinoma (HCC) is the fourth most common cause of cancer-related death worldwide. Risk factors for HCC include chronic hepatitis B and hepatitis C, alcohol addiction, metabolic liver disease (particularly nonalcoholic fatty liver disease) and exposure to dietary toxins such as aflatoxins and aristolochic acid. All these risk factors are potentially preventable, highlighting the considerable potential of risk prevention for decreasing the global burden of HCC. HCC surveillance and early detection increase the chance of potentially curative treatment; however, HCC surveillance is substantially underutilized, even in countries with sufficient medical resources. Early-stage HCC can be treated curatively by local ablation, surgical resection or liver transplantation. Treatment selection depends on tumour characteristics, the severity of underlying liver dysfunction, age, other medical comorbidities, and available medical resources and local expertise. Catheter-based locoregional treatment is used in patients with intermediate-stage cancer. Kinase and immune checkpoint inhibitors have been shown to be effective treatment options in patients with advanced-stage HCC. Together, rational deployment of prevention, attainment of global goals for viral hepatitis eradication, and improvements in HCC surveillance and therapy hold promise for achieving a substantial reduction in the worldwide HCC burden within the next few decades.
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Affiliation(s)
- Ju Dong Yang
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
- Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Pierre Hainaut
- Tumor Molecular Biology and Biomarkers Group, Institute for Advanced Biosciences, Inserm U 1209 CNRS UMR5309, Université Grenoble Alpes, Grenoble, France
| | - Gregory J Gores
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Amina Amadou
- Tumor Molecular Biology and Biomarkers Group, Institute for Advanced Biosciences, Inserm U 1209 CNRS UMR5309, Université Grenoble Alpes, Grenoble, France
| | - Amelie Plymoth
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Lewis R Roberts
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
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17
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Abstract
PURPOSE Chronic hepatitis B virus (HBV) infection remains endemic and continues to cause significant morbidity and mortality. It is a global health issue and the World Health Organization aims to eradicate HBV by 2030. Since vertical transmission accounts for the majority of chronic HBV infection, pregnancy offers an excellent opportunity to achieve complete HBV eradication by providing effective immunization of the offspring. METHODS We reviewed recent publications identified from PubMed database using a combination of the relevant keywords for HBV, pregnancy, vertical transmission, immunoprophylaxis failure and antiviral treatment. RESULTS We summarized the evidence of factors associated with, and measures to reduce and prevent maternal to child transmission, including the use of antiviral treatment during pregnancy to prevent immunoprophylaxis failure. Evidence suggested that highly viremia mother can be offered antenatal antiviral treatment to prevent immunoprophylaxis failure. We elaborated the viral load threshold to start maternal antiviral treatment and the importance of timely neonatal vaccination. A clinical algorithm to manage HBV carriers during pregnancy was proposed. CONCLUSION Eradication of HBV is achievable with optimal management of HBV carriers, especially during pregnancy by interruption of vertical transmission. Routine antenatal screening and neonatal immunoprophylaxis remain the key measures to reduce the global HBV burden, and additional antenatal antiviral treatment could further minimize the chance of persistent infection in newborns.
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Affiliation(s)
- Ka Wang Cheung
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, 6/F, Professorial Block, 102 Pokfulam Road, Hong Kong SAR, China.
| | - Mimi Tin Yan Seto
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, 6/F, Professorial Block, 102 Pokfulam Road, Hong Kong SAR, China
| | - Terence Tzu-Hsi Lao
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, 6/F, Professorial Block, 102 Pokfulam Road, Hong Kong SAR, China
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18
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Jourdain G, Ngo-Giang-Huong N, Khamduang W. Current progress in the prevention of mother-to-child transmission of hepatitis B and resulting clinical and programmatic implications. Infect Drug Resist 2019; 12:977-987. [PMID: 31118703 PMCID: PMC6499137 DOI: 10.2147/idr.s171695] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 03/25/2019] [Indexed: 12/14/2022] Open
Abstract
There is currently no cure for hepatitis B chronic infections. Because new hepatitis B infections result mainly from perinatal transmission, preventing mother-to-child transmission is essential to reach by 2030 the goal of hepatitis B elimination set by the World Health Organization. The universal administration of hepatitis B vaccine to all infants, regardless of maternal status, starting with the birth dose, is the cornerstone of the strategy for elimination. Additional interventions, such as hepatitis B immune globulin administered to newborns and antiviral prophylaxis administered to hepatitis B infected pregnant women, may contribute to reaching the goal earlier. Hepatitis B immune globulin may remain out for reach of many pregnant women in low- and middle-income countries due to cost and logistic issues, but antivirals are cheap and do not require a cold chain for distribution. However, it has been observed that some viruses harbor mutations associated with escape from vaccine-elicited antibodies following immunization or administration of hepatitis B immune globulin. Also, resistance associated mutations have been described for several drugs used for treatment of hepatitis B infected patients as well as for the prevention of mother-to-child transmission. Whether these mutations have the potential to compromise the prevention of mother-to-child transmission or future treatment of the mother is a question of importance. We propose a review of important recent studies assessing tenofovir disoproxil fumarate for the prevention of mother-to-child transmission, and provides detailed information on the mutations possibly relevant in this setting.
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Affiliation(s)
- Gonzague Jourdain
- Unit 174-PHPT, Institut de recherche pour le développement (IRD), Marseille, France.,Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand.,Department of Immunology and Infectious Diseases, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Nicole Ngo-Giang-Huong
- Unit 174-PHPT, Institut de recherche pour le développement (IRD), Marseille, France.,Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand.,Department of Immunology and Infectious Diseases, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Woottichai Khamduang
- Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
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19
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Maraolo AE, Gentile I, Buonomo AR, Pinchera B, Borgia G. Current evidence on the management of hepatitis B in pregnancy. World J Hepatol 2018; 10:585-594. [PMID: 30310536 PMCID: PMC6177570 DOI: 10.4254/wjh.v10.i9.585] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 04/26/2018] [Accepted: 06/09/2018] [Indexed: 02/06/2023] Open
Abstract
Hepatitis B virus (HBV) infection is one of the main public health problems across the globe, since almost one third of the world population presents serological markers of contact with the virus. A profound impact on the epidemiology has been exerted by universal vaccination programmes in many countries, nevertheless the infection is still widespread also in its active form. In the areas of high endemicity (prevalence of hepatitis B surface antigen positivity > 7%), mother-to-child transmission represents the main modality of infection spread. That makes the correct management of HBV in pregnancy a matter of utmost importance. Furthermore, the infection in pregnancy needs to be carefully assessed and handled not only with respect to the risk of vertical transmission but also with respect to gravid women health. Each therapeutic or preventive choice deserves to be weighed upon attentively. On many aspects evidence is scarce or controversial. This review will highlight the latest insights into the paramount steps in managing HBV in pregnancy, with particular attention to recommendations from recent guidelines and data from up-do-date research syntheses.
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Affiliation(s)
- Alberto Enrico Maraolo
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples 80131, Italy
| | - Ivan Gentile
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples 80131, Italy
| | - Antonio Riccardo Buonomo
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples 80131, Italy
| | - Biagio Pinchera
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples 80131, Italy
| | - Guglielmo Borgia
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples 80131, Italy
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20
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Abstract
Hepatitis B virus (HBV) is a small nonenveloped DNA virus that is a member of the Hepadnaviridae family. Chronic HBV infection is estimated to effect more than 350 million people worldwide with over 2 billion people being exposed to the virus. Risk factors for chronic infection include age of exposure to the virus, concurrent immunosuppression and HIV infection. Individuals chronically infected are 200 times more likely to develop hepatocellular carcinoma (HCC) than uninfected individuals and are at risk of developing cirrhosis and the risks of decompensated liver disease. This article focuses on the recent therapeutic advances that reduce the risk of developing these complications, those that prevent the spread of HBV and strategies for the prevention of post-liver-transplantation recurrence of HBV.
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Affiliation(s)
- Johanne Brooks
- Gastroenterology Department, Norfolk and Norwich Hospital, Colney Lane, Norwich NR4 7UY, UK
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