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Hepatitis B Diagnosis & Monitoring, Hepatitis B Prevention, Living with Hepatitis B

Expert Calls for Viral Load Testing in All Pregnant Women with Hepatitis B

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Dr. Ravi Jhaveri, an infectious disease specialist at the University of North Carolina at Chapel Hill School of Medicine, talks to parents.
Dr. Ravi Jhaveri, an infectious disease specialist at the University of North Carolina at Chapel Hill School of Medicine, talks to parents.

Today, all pregnant women are routinely screened for hepatitis B, but a growing number of doctors say this single test doesn’t go far enough to protect the health of women and children.

In a commentary published in the medical journal Pediatrics,  infectious disease specialist Dr. Ravi Jhaveri calls for a mandatory second test in pregnant women infected with hepatitis B. This test would measure the amount of hepatitis B virus (HBV) in her body (called viral load).

When women have high viral loads, their newborns can become infected even if they are immunized at birth and treated with HBIG (hepatitis B antibodies) to prevent infection. Continue reading "Expert Calls for Viral Load Testing in All Pregnant Women with Hepatitis B" →

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HBV Journal Review – June 2014

ChrisKHBF is pleased to connect our blog readers to Christine Kukka’s monthly HBV Journal Review that she writes for the HBV Advocate. The journal presents the
 latest in hepatitis B research, treatment, and prevention from recent academic and medical journals. This month, the following topics are explored:

  • Belatedly, National Panel Recommends Screening At-Risk Patients for Hepatitis B
  • Genotypes and Mutations Define the Course of Hepatitis B Infection
  • Older Patients Who Lose HBeAg After Treatment May Relapse
  • Tenofovir Proves Ineffective in Patient with Multiple Drug Resistance
  • Nearly All HBeAg-Negative Patients Relapse After Antiviral Treatment Stops
  • Studies Find Hepatitis Infection Does Not Increase Pancreatic Cancer Risk
  • Screening Pregnant Women for High Viral Loads Is Cost Effective
  • Hepatitis B Appears to Impede Fertility
  • Despite Low Viral Load, Infected People Can Still Infect Family Members
  • Good News: HBV Infection Rates Lower Than Expected Among Korean-Americans
  • Green Tea May Be an Effective Antiviral

HBV Journal Review

June 1, 2014
Volume 11, Issue 6
by Christine M. Kukka

Belatedly, National Panel Recommends Screening At-Risk Patients for Hepatitis B

Ten years after it recommended against screening the “general population” for hepatitis B, an independent national task force that creates prevention guidelines for primary care providers has finally recognized that certain high risk groups in the U.S. should be screened for hepatitis B.

Their recommendations, recently published in the Annals of Internal Medicine, come after numerous studies faulted primary care providers for failing to screen patients for hepatitis B and missing opportunities to treat patients for liver disease and immunize family members against hepatitis B virus (HBV) infections.

Other health care organizations, including the U.S. Centers for Disease Control and Prevention (CDC), the Institute of Medicine, and the American Association for the Study of Liver Disease, have been recommending for years that primary care doctors screen high-risk patients for hepatitis B, which has infected up to 2.2 million Americans.

The U.S. Preventive Services Task Force (USPSTF) recently issued clinical guidelines recommending that doctors screen the following patients for hepatitis B:

  • People from countries that have hepatitis B rates exceeding 2% (which includes Asia, Africa, Central Europe and parts of Central and South America).
  • U.S.-born people whose parents immigrated from countries with high rates of HBV infection.
  • HIV-positive people, injecting drug users, men who have sex with men, and
  • Household contacts of people infected with HBV.

The task force’s guidelines suggest that because an effective vaccine to protect against the infection and effective treatments for hepatitis B are now available, they decided to issue these recommendations. However, both the vaccine and effective treatments have been available for more than a decade.

“In the 2004 recommendation, the USPSTF focused only on the general population,” the authors wrote in the recommendations. “In the current recommendation, the USPSTF focused on high-risk populations as it considered new evidence on the benefits and harms of antiviral treatment, the benefits of education or behavior change counseling, and the association between improvements in intermediate and clinical outcomes after antiviral treatment.” The task force noted that it, “…found inadequate evidence that education or behavior change counseling reduces disease transmission.”

Source: www.uspreventiveservicestaskforce.org/uspstf/
uspshepb.htm

Genotypes and Mutations Define the Course of Hepatitis B Infection
Researchers are increasingly finding that HBV genotypes or strains—and the mutations that they generate—can determine the severity of a patient’s infection.

Each of the world’s 10 genotypes and their mutations have different characteristics that can increase risk of cirrhosis and liver cancer, determine whether an infection becomes chronic, and basically determine a patient’s destiny, according to a recent study, published in the May issue of the World Journal of Hepatology …

Continue reading the HBV Journal Review… 

Hepatitis B Treatment, Living with Hepatitis B

HBV Journal Review – May 2014

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ChrisKHBF is pleased to connect our blog readers to Christine Kukka’s monthly HBV Journal Review that she writes for the HBV Advocate. The journal presents the
 latest in hepatitis B research, treatment, and prevention from recent academic and medical journals. This month, the following topics are explored:

  • Adding Interferon to Ongoing Antiviral Treatment Is Highly Successful
  • Vitamin E Helps HBV-Infected Children Lose HBeAg, Reducing Liver Damage
  • Common Chinese Toad May Hold the Key to Preventing and Treating Liver Cancer
  • Even at Top Hospitals, Doctors Fail to Treat Hepatitis B Patients Properly
  • Study Finds Doctors More Likely to Treat Hepatitis B in Men Than Women
  • Study Confirms Doctors Frequently Fail to Screen and Vaccinate Those at Risk
  • Antiviral Treatment Dramatically Improves Liver Cancer Test Accuracy
  • $50 Cash Incentive Increases HBV Immunization 12-Fold
  • Hepatitis B and C Cause Ten-Times More Deaths Than HIV in Europe

HBV Journal Review
May 1, 2014
Volume 11, Issue 5
by Christine M. Kukka

Adding Interferon to Ongoing Antiviral Treatment Is Highly Successful 

Adding pegylated interferon to ongoing antiviral treatment produced remarkable rates of hepatitis B “e” antigen (HBeAg) loss and even hepatitis B surface antigen (HBsAg) loss, according to a study presented at the International Liver Congress held in London in April.

Eighty-three HBeAg-positive patients in China, who had been on antivirals for more than two years, had 48 weeks of interferon treatment added to their treatment regimen. A control group continued on only antivirals:

  • 60% of the group treated with add-on interferon lost HBeAg and their viral loads dropped below 2,000 IU/mL. In contrast, only 13.8% of patients treated with only antivirals achieved those benchmarks.
  • 27.7% of patients in the combination treatment group lost HBsAg. No one in the antiviral group lost HBsAg.
  • All patients who had low HBsAg levels (less than 1,000 IU/mL) at the start of interferon treatment achieved HBeAg loss and 91% cleared HBsAg.

” Sequential combination therapy of (antivirals) and pegylated interferon effectively resulted in high rates of complete response and HBsAg loss in patients with prior long-term exposure to (antivirals),” researchers wrote. (Abstract 0117)

Another study exploring the benefits of sequential antiviral and interferon treatment found that HBeAg-positive patients who had been on antivirals for three years or longer also experienced high rates of HBeAg loss and development of “e” antibodies (HBeAg seroconversion) when their antivirals were replaced with pegylated interferon.

At week 48, the HBeAg seroconversion rate in the interferon-treated group was 66.67% compared to 2.5% in the antiviral group. (Abstract P1071)

A third study from India also found notable improvements when pegylated interferon was added to ongoing tenofovir treatment. Sixty patients were treated with tenofovir for 12 weeks (300 mg daily), then:

  • One group had pegylated interferon added to the ongoing tenofovir regimen for 24 weeks, and then were followed for another 28 weeks.
  • The other half continued their tenofovir treatment for 52 weeks.

Sixty percent of the interferon-plus-tenofovir group achieved healthy liver health, with normal alanine aminotransferase (ALT) levels, compared to 30% in the tenofovir-only group. The combination-treatment group also experienced greater viral load (HBV DNA) declines and HBeAg seroconversion (53.3% vs. 23.3% in the antiviral-only group).

“Sequential therapy using tenofovir and pegylated interferon may provide rapid and high biochemical and virological response in selected HBeAg-positive patients,” researchers noted. “Long-term clinical trials are needed to assess (the) sustained durable response.” (Abstract P1092)

Source: www.hbvadvocate.org/EASL_2014_
Abstracts.pdf

Vitamin E Helps HBV-Infected Children Lose HBeAg, Reducing Liver Damage

A small study, presented at the 2014 Liver Congress found that HBeAg-positive children who were treated with vitamin E (15 mg/kg/daily) for 12 months achieved higher rates of HBeAg conversion, lower viral loads and normal ALT levels than did untreated children.

Continue reading the HBV Journal Review… 

 

Hepatitis B Treatment, Living with Hepatitis B

HBV Journal Review – February 2014

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ChrisKHBF is pleased to connect our blog readers to Christine Kukka’s monthly HBV Journal Review that she writes for the HBV Advocate. The journal presents the
latest in hepatitis B research, treatment, and prevention from recent academic and medical journals. This month, the following topics are explored:

  • Tests for Antigens and Drug-Resistant Virus Emerge as Valuable Diagnostic Tools
  • Experts Issue a Report Card on Side Effects from Antivirals
  • Experts Weigh in on Why They Prefer Either Antivirals or Interferon
  • Doctors Explain Which Medical Guidelines They Follow, Or Ignore
  • Truvada Effective in Lowering Viral Load in Young Adults with High Viral Load
  • Hepatitis B Causes Most Liver Cancer Deaths in China
  • Smoking Shortens Survival after Liver Cancer Surgery

 HBV Journal Review

February 1, 2014
Vol 11, no 2
by Christine M. Kukka

Tests for Antigens and Drug-Resistant Virus Emerge as Valuable Diagnostic Tools

Measuring the amount of hepatitis B surface antigen (HBsAg) in your bloodstream or conducting quick tests for drug-resistant hepatitis B virus (HBV) may soon be part of your office visit in the brave new molecular world of hepatitis B treatment.

Doctors increasingly are measuring HBsAg levels to determine if treatment is needed or if current medications are working. HBsAg tests—along with measuring alanine aminotransferase (ALT) for signs of liver damage and HBV DNA for viral load—may become essential tools to assess hepatitis B progression or remission.

HBsAg is the protein that makes up the outer covering of HBV. When a patient has a high viral load (and is positive for the hepatitis B “e” antigen—HBeAg), there are often large quantities of HBsAg circulating in the blood stream. When viral replication slows and HBeAg disappears, there can be lower quantities of HBsAg.

But experts are learning that high HBsAg levels can increase cancer risk, even in HBeAg-negative patients, according to a study published in the journal Annales de Biologie Clinique. (1) As a result, there is heightened attention on HBsAg as a key indicator of a patient’s health. For example:

  • In HBeAg-negative patients, HBsAg levels less than 1,000 international units per milliliter (IU/mL) along with low viral load (HBV DNA) under 2,000 IU/mL indicate the patient is an “inactive” patient.
  • When patients are treated with pegylated interferon, doctors can tell if the treatment is working if there is a decline in HBsAg levels within 12 weeks. This early indicator can save money if the drug isn’t working and help to avoid uncomfortable side effects. Doctors recommend patients with genotypes B and C should stop interferon at week 12 if their HBsAg levels remain at 20,000 UI/mL or higher.

Another team of French researchers, also exploring the implications of HBsAg in an article published in the February 2014 issue of the journal Liver International, suggest that as HBsAg levels decline, so does the risk of liver cancer.

They also suggest that during antiviral treatment, a rapid decline in HBsAg may indicate which patients will eventually clear HBsAg. A 100-fold decline or more of HBsAg over six months of treatment, “… could be a marker of a sustained response after treatment cessation,” they wrote.(2)

In another diagnostic breakthrough, researchers writing in the December journal of Clinical Molecular Hepatology promoted the value of a HepB Typer-Entecavir kit that can precisely detect HBV that have viral mutations that can “resist” the antiviral drug entecavir (Baraclude). This diagnostic tool allows doctors to select the most effective antiviral for each individual patient based on the molecular makeup of their HBV.(3)

1. Source: www.ncbi.nlm.nih.gov/pubmed/24235324  
2. Source: www.ncbi.nlm.nih.gov/pubmed/24373085  
3. Source: www.ncbi.nlm.nih.gov/pubmed/24459645

Experts Issue a Report Card on Side Effects from Antivirals
Hong Kong researchers evaluated the side effects of commonly-used antivirals in the December 2013 issue of the Journal of Gastroenterology and Hepatology. Antivirals disrupt the genetic make-up of HBV, making it difficult for the virus to replicate. While generally safe, patients must take antiviral pills daily over several years and side effects include damage to the mitochondria of the body’s cells (called mitochondria toxicity.)

Continue reading this and additional studies for Februrary

Hepatitis B Prevention, Hepatitis B Treatment, Living with Hepatitis B

HBV Journal Review – January 2014

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HBF is pleased to connect our blog readers to Christine Kukka’s monthly HBV Journal Review that she writes for the HBV Advocate. The journal presents the
 latest in hepatitis B research, treatment, and prevention from recent academic and medical journals. This month, the following topics are explored: Continue reading "HBV Journal Review – January 2014" →

Hepatitis B Treatment, Living with Hepatitis B

HBV Journal Review – December 2013

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HBF is pleased to connect our blog readers to Christine Kukka’s monthly HBV Journal Review that she writes for the HBV Advocate. The journal presents the
latest in hepatitis B research, treatment, and prevention from recent academic and medical journals. This month, the following topics are explored: Continue reading "HBV Journal Review – December 2013" →

Hepatitis B Diagnosis & Monitoring, Hepatitis B Prevention, Hepatitis B Treatment, Living with Hepatitis B

HBV Journal Review – October 2013

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HBF is pleased to connect our blog readers to Christine Kukka’s monthly HBV Journal Review that she writes for the HBV Advocate. The journal presents the
latest in hepatitis B research, treatment, and prevention from recent academic and medical journals. This month, the following topics are explored:

  • Study Finds Only 21% of Hepatitis B Patients Are Treated Correctly
  • Combination of Chinese Herbs Plus Antiviral Entecavir Proves Effective
  • Caesarians Reduce Infection of Newborns When Mothers Have High Viral Loads
  • Combined Antiviral and Interferon Treatment Effective in Those Under Age 30
  • New Tenofovir Formula May Lead to Less Bone Loss and Kidney Problems
  • HBV Mutation Found Only in Men May Explain Their Higher Rates of Liver Damage
  • Sumo Wrestlers Found to Transmit HBV Infection
  • Taiwan’s Hepatitis B Immunization of Infants Reduces Hepatitis B by 90%
  • Tenofovir Reverses Severe, Decompensated Cirrhosis

HBV Journal Review
October 1, 2013
Volume 10, Issue 10
by Christine M. Kukka 

Study Finds Only 21% of Hepatitis B Patients Are Treated Correctly

A new study, examining how well San Francisco primary care providers care for their patients infected with the hepatitis B virus (HBV), finds most fail to screen them for liver cancer or regularly evaluate their viral load or hepatitis B “e” antigen (HBeAg) status, though medical guidelines require annual or semi-annual testing.

The study, published in the September 2013 issue of the journal Digestive Diseases and Sciences, surveyed doctors who provide care through a safety net program to many uninsured patients. They were asked how well they thought they followed current medical guidelines, and then patient medical records were analyzed to assess the true quality of care.

Of the 148 doctors surveyed, 79% claimed to follow medical guidelines and monitor patients’ liver health every 6 six 12 months. However, patient medical records covering the last 12 months showed substandard care.

  • • Only 75% of patients had their alanine aminotransferase (ALT) levels, which shows liver damage, tested in the past year.
  • • Only 51% had their viral load (HBV DNA) tested.
  • • Only 51% had been screened for liver cancer (either with an alpha fetoprotein test or some type of liver imaging). This test should be performed annually, and doctors are at risk of medical malpractice if they do not screen patients for cancer.
  • • HBeAg tests were performed in only 29% of patients.
  • • Only 32% of the hepatitis B patients had been immunized against hepatitis A, another guideline requirement, to protect them from another liver infection.

Bottom line, researchers found that only 21% of patients had been monitored properly in compliance with current hepatitis B guidelines. Forty-three percent of doctors were not familiar with medical guidelines for hepatitis B management and only 73% answered all questions about hepatitis B correctly.

There was also a racial bias regarding which HBV-infected patients were screened for hepatitis C and HIV. Doctors tended to test African-American and Latino patients for hepatitis C (48% and 44% respectively) at a higher rate than they tested whites and Asian-American patients (34% and 31%.)

The study suggests that fear of malpractice—more than knowledge of current practice guidelines—may drive doctors to perform the required liver cancer screenings each year. Also, the researchers suggest that hepatitis B public education initiatives, spearheaded by the San Francisco Hepatitis B Free Campaign, may have contributed to better monitoring of Asian-Americans because it raised awareness among the public and their providers.

“These findings highlight the importance of targeted provider education to improve overall care,” for hepatitis B, the researchers from the University of California, San Francisco, suggest.

Continue reading about this and additional HBV related studies

Hepatitis B Diagnosis & Monitoring, Hepatitis B Prevention, Hepatitis B Treatment

HBV Journal Review – September 2013

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HBF is pleased to connect our blog readers to Christine Kukka’s monthly HBV Journal Review that she writes for the HBV Advocate. The journal presents the
latest in hepatitis B research, treatment, and prevention from recent academic and medical journals. This month, the following topics are explored:

  • 39.2% of U.S. Newborns Aren’t Getting Hepatitis B Vaccine at Birth
  • Researchers Suggest Banning or Restricting Lamivudine to Avoid Drug Resistance
  • Knowledge Gap About Hepatitis B Persists Among Asian-Americans
  • Even Liver Specialists Fail to Immunize Patients Against Viral Hepatitis
  • Many Seek Viral Hepatitis Tests Only When Symptoms Appear
  • After Six Years of Tenofovir Treatment, Still No Signs of Drug Resistance
  • More Studies Examine Link Between Vitamin D and Liver Damage
  • Study Examines Which Hepatitis B Patients Relapse with Chemotherapy
  • Interferon Treatment May Cause Some Hearing Loss
  • African-Americans Suffer the Highest Rates of New HBV Infections in the U.S.

HBV Journal Review
September 1, 2013
Volume 10, Issue 8
by Christine M. Kukka 

 

 39.2% of U.S. Newborns Aren’t Getting Hepatitis B Vaccine at Birth

Which newborns aren’t getting immunized against hepatitis B in the U.S.? The infants who:

  • • Do not have health insurance
  • • Live in states without a universal hepatitis B vaccine supply policy
  • • And have only one provider who administered vaccines.

According to a U.S. Centers for Disease Control and Prevention study, published in the August issue of the journal Preventive Medicine, an alarming 39.2% of newborns missed the first, critical birth dose of hepatitis B vaccination that can protect newborns from hepatitis B even if their mothers are infected.

These results come from data analysis of the 2009 National Immunization Survey of 17,053 U.S. children, aged 19-35 months.

“Children who reside in states without a universal hepatitis B vaccine supply policy, and are not covered by health insurance are two important modifiable risk factors for not receiving the birth dose hepatitis B vaccination, future intervention studies could be needed to help control those modifiable risk factors,” CDC researchers wrote.

Source: www.ncbi.nlm.nih.gov/pubmed/23988497

Researchers Suggest Banning or Restricting Lamivudine to Avoid Drug Resistance
A global team of researchers suggest lamivudine (Epivir-HBV) never be used to treat hepatitis B patients because it frequently leads to drug resistance and sets the stage for resistance to other antivirals, such as entecavir (Baraclude).

Lamivudine, the first antiviral approved for hepatitis B treatment, has fallen out of favor in North America and Europe because of its high rate of drug resistance. But because of its low cost, it continues to be commonly used to treat hepatitis B virus (HBV) infection in Asia and Africa, where the majority of the world’s hepatitis B patients live.

This report, published in the July 30 issue of PLoS One, examined the molecular make-up of the virus in many patients who had been treated with lamivudine as well as patients who had never been treated. They found the many untreated patients carry a mutation that allows HBV to quickly mutate and develop resistance to lamivudine.

“Our findings strongly suggest that the use of lamivudine will not benefit …patients,” they wrote because of the high risk of lamivudine resistance.

“Finally, since patients can quickly develop drug resistance to entecavir in the presence of lamivudine mutations, the lamivudine mutations can significantly compromise the efficacy of entecavir,” they concluded.

They proposed that doctor screen patients for these mutations before ever prescribing lamivudine,”… to most effectively treat chronic hepatitis B patients by selecting only sensitive drugs.” …

Continue reading about this and additional HBV related studies

Hepatitis B Treatment, Living with Hepatitis B

HBV Journal Review – August 2013

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HBF is pleased to connect our blog readers to Christine Kukka’s monthly HBV Journal Review that she writes for the HBV Advocate. The journal presents the
latest in hepatitis B research, treatment, and prevention from recent academic and medical journals. This month, the following topics are explored:

*First Clinical Trial Using “RNA Interference” for Hepatitis B Begins
*Why Do Some People Clear HBsAg After Years of Chronic Infection?
*Longer Antiviral Treatment Urged after Seroconversion to Prevent Relapse
*Federal Officials Dramatically Undercount Liver Disease Deaths in the U.S.
*More Women Than Men Retain Protection Against Hepatitis B After
*Immunization Hepatitis B Cirrhosis Declines in China, But Alcohol-related
*Cirrhosis Rises Hepatitis E Vaccine Development Shows Promise
*Tenofovir Most Effective Antiviral Treatment in HIV-HBV Coinfected Patients
*Study Confirms Coffee Protects the Liver in European Populations
*Hepatitis C Is Also a Risk for Southeast Asians, Including Women
*In Small Trial, Chinese Herbal Medicine Reduces ALT Levels

HBV Journal Review
August 1, 2013
Volume 10, Issue 8
by Christine M. Kukka

First Clinical Trial Using “RNA Interference” for Hepatitis B Begins

A ground-breaking approach to hepatitis B treatment, which manipulates RNA messengers to halt viral replication, has begun its first human clinical trial. If successful, this approach would be a paradigm shift in treatment, possibly re- placing interferon and antivirals.

In animal trials, reported in the May 2013 journal Molecular Therapy, RNA interference (RNAi) treatment reduced hepatitis B surface antigen (HBsAg) levels to undetectable within 24 hours in mice and the antigen remained undetectable for nearly a month.

RNAi treatment works by destroying or “silencing” the molecular messengers that carry im- portant genetic information to the hepatitis B virus (HBV) antigen/ protein factories. Without the critical information that messenger RNA molecules carry, these antigen factories shut down and HBV reproduction de- clines dramatically.

Early RNAi research found that RNA silencing worked extremely well in the liver, but the challenge has been to create a formula and delivery system to target hepatitis B antigens in liver cells without affecting other important cells.

Arrowhead Research Corp. found that when the small RNA interrupters are linked to cholesterol, they target liver cells extremely well, and the addition of special polymers helps the gene silencing process. Arrowhead designed an intravenous formula, called ARC-520, that is utilized in its Phase 1 trial.

The hope is that when the viral load is dramatically reduced, the body’s immune system can gain the upper hand and eradicate the infection on its own.

In addition to its mouse trial, a similar trial involving an HBV infected chimp with an extremely high viral load also led to rapid reduction in HBV DNA and a 90% reduction in another hepatitis B antigen—the hepatitis B “e” antigen (HBeAg).

The clinical trial of ARC-520 (which uses a Dynamic Polyconju- gate delivery platform and includes two distinct RNA silencing agents that should shut down hepatitis B anti- gen reproduction) in humans is taking place in Melbourne, Australia. It is a randomized, double-blind, placebo- controlled trial. Each group of six healthy volunteers will receive either a placebo intra- venous injection or a single dose of ARC- 520…
Continue reading about this and additional studies…

 

Hepatitis B Diagnosis & Monitoring, Hepatitis B Treatment

HBV Journal Review – July 2013

HBF is pleased to connect our blog readers to Christine Kukka’s monthly HBV Journal Review that she writes for the HBV Advocate. The journal presents the
latest in hepatitis B research, treatment, and prevention from recent academic and medical journals. This month, the following topics are explored:

*Experts Describe When to Treat Pregnant Women with Antivirals
Does pregnancy worsen hepatitis B?
When should pregnant women be treated?
Which antivirals are safe to use during pregnancy?
What if women have elevated ALTs before becoming pregnant and have never         been treated?
What about women with normal ALTs and high viral loads?
Is it safe to use antivirals during the entire pregnancy?
Monitoring recommendations after delivery
Can a woman taking antivirals breastfeed?
* Half of Patients Treated Long-Term with Tenofovir Lose HBeAg
*Even Patients with High Viral Load Lose HBeAg with Tenofovir
*New Type of Interferon Effective in Phase 2 Hepatitis B Trial
*Majority of Hepatitis B Patients Have Vitamin D Deficiency
*But Patients with Healthy Vitamin D Levels Are More Likely to Clear HBsAg
*Activists Develop a National Plan to Eradicate Hepatitis B in the U.S.
*New Guidelines Urge Britain’s Doctors to Improve Hepatitis B Care
*Measuring HBsAg Levels May Identify Fibrosis and Avoid Liver Biopsies
*HBsAg Levels May Also Predict Cancer Risk in HBeAg-negative Patients

HBV Journal Review


July 1, 2013, Vol 10, no 7
by Christine M. Kukka

Experts Describe When to Treat Pregnant Women with Antivirals
Two U.S. hepatitis B experts have crafted guidelines for doctors to use when deciding when to treat pregnant women infected with the hepatitis B virus (HBV) with antivirals in order to safeguard the women’s health and prevent infection of newborns.

More than half of new hepatitis B infections result from mother-to-child (vertical) transmission and despite immediate immunization and administration of HBIG (hepatitis antibodies), about 30% of infants born to women with high viral loads become infected. Additionally, women who want to become pregnant may already be treated with antivirals because of liver damage.  There is little medical guidance on whether treatment is safe over the entire pregnancy.

Does pregnancy worsen hepatitis B? Generally it does not unless the woman has cirrhosis (severe liver scarring.) Studies show a pregnant woman’s viral load generally does not increase over a pregnancy, but after the baby is born and the woman’s hormone levels change (akin to a sudden decline in steroids), some women experience a “flare” and their alanine transaminase (ALT) levels may increase due to moderate liver cell damage. Because of these flares, doctors must monitor new mothers carefully for several weeks after childbirth.

When should pregnant women be treated? Starting in the second or third trimester of pregnancy, antiviral treatment is recommended when women have high viral loads—exceeding 1 million copies per milliliter or 200,000 international units per milliliter. However, if women are already receiving antiviral treatment when they become pregnant, treatment should probably continue over the pregnancy to prevent worsening liver disease.

Which antivirals are safe to use during pregnancy? The experts recommend tenofovir (Viread) in the event the woman continues to need antiviral treatment because this drug has a very low rate of drug resistance, or telbivudine (Tyzeka). Both have been shown to be safe and cause no birth defects when used in pregnant women infected with HIV or HBV.

Continue reading about this and additional studies…


Baruch S. Blumberg Institute