Challenge of HBV prevention at pregnancy The Hong Kong Association - PowerPoint PPT Presentation

The Hong Kong Association for the Study of Liver Diseases Challenge of HBV prevention at pregnancy The Hong Kong Association for the Study of Liver Diseases The Hong Kong Association for the Study of Liver Diseases The Hong Kong Association for the Study of Liver Diseases The Hong Kong Association for the Study of Liver Diseases The Hong Kong Association for the Study of Liver Diseases Teerha Piratvisuth MD. NKC Institute of Gastroenterology and Hepatology The Hong Kong Association for the Study of Liver Diseases Prince of Songkla University, Thailand

The Hong Kong Association for the Study of Liver Diseases Disclosures The Hong Kong Association for the Study of Liver Diseases The Hong Kong Association for the Study of Liver Diseases • Receipt of grants/research support: – Gilead Sciences, Roche Diagnostic, Janssen, Fibrogen The Hong Kong Association for the Study of Liver Diseases • Participation in a company- sponsored speakers’ bureau: – Bristol-Myers Squibb, Gilead Sciences, Bayer, Abbott and MSD The Hong Kong Association for the Study of Liver Diseases The Hong Kong Association for the Study of Liver Diseases The Hong Kong Association for the Study of Liver Diseases

The Hong Kong Association for the Study of Liver Diseases Prevalence of chronic HBV infection The Hong Kong Association for the Study of Liver Diseases among pregnant women % The Hong Kong Association for the Study of Liver Diseases 30 30 28 28 26 26 24 24 2-20% 22 22 The Hong Kong Association for the Study of Liver Diseases 20 20 18 18 16 16 14 14 10% 12 12 1-9% The Hong Kong Association for the Study of Liver Diseases 10 10 8 2-5% 6 4 0.8% <0.1 - 4% 2 The Hong Kong Association for the Study of Liver Diseases 0 India Europe China Thailand Middle East Japan The Hong Kong Association for the Study of Liver Diseases Sinha S. et al. Hepatology Research 2010: 40.

The Hong Kong Association for the Study of Liver Diseases Vertical transmission: Key factor of HBV infection in The Hong Kong Association for the Study of Liver Diseases endemic area The Hong Kong Association for the Study of Liver Diseases In endemic area, Over > 90% become 50% acquired their chronic HBV The Hong Kong Association for the Study of Liver Diseases infection vertically from infection their mothers The Hong Kong Association for the Study of Liver Diseases Management of chronic 240 million people with chronic HBV infection HBV in pregnancy and strategies to prevent The Hong Kong Association for the Study of Liver Diseases MTCT of HBV Lavanchy D. J Clin Virol 2005: S1-3. The Hong Kong Association for the Study of Liver Diseases Jonas MM. Liver Int. 2009: S133-9.

The Hong Kong Association for the Study of Liver Diseases Effects of pregnancy on chronic HBV infection The Hong Kong Association for the Study of Liver Diseases Normal pregnancy The Hong Kong Association for the Study of Liver Diseases � Adrenal corticosteroids Host immune response Modulation of cytokines The Hong Kong Association for the Study of Liver Diseases Increase in HBV DNA levels but The Hong Kong Association for the Study of Liver Diseases decrease in ALT The Hong Kong Association for the Study of Liver Diseases Hepatitis flares at late pregnancy or postpartum Tan HH. etal. Hepatol Int. 2008: 370-5. The Hong Kong Association for the Study of Liver Diseases Nguyen G etal. Aliment Pharmacol Ther. 2009: 755-64. ter Borg MJ. et al.J Viral Hepatol. 2008; 15: 37-41

The Hong Kong Association for the Study of Liver Diseases Postpartum hepatitis flare in HBsAg-positive mothers The Hong Kong Association for the Study of Liver Diseases % 100 100 The Hong Kong Association for the Study of Liver Diseases 90 90 80 80 70 70 60 60 The Hong Kong Association for the Study of Liver Diseases 45% 43% 50 50 40 40 30 30 12-17% 20 20 The Hong Kong Association for the Study of Liver Diseases 10 10 0 HBeAg Seroconversion Increased ALT Overt liver dysfunction within 6 months within 1 months in The Hong Kong Association for the Study of Liver Diseases HBeAg-positive mothers (n=269) ter Borg MJ. etal. J Viral Hepat. 2008: 37-41. Tagawa H. etal. Nihon Sanka Fujinka Gakkai Zasshi. 1987 Jan;39(1):24-30 The Hong Kong Association for the Study of Liver Diseases Lin HH. etal. Gastroenterol Hepaterol. 2006: 605-9.

The Hong Kong Association for the Study of Liver Diseases The impact of maternal HBsAg carriers on pregnancy outcomes The Hong Kong Association for the Study of Liver Diseases % : Maternal HBsAg carriers, n=253 30 30 : Controls matched for age and parity and year of delivery, n=253 The Hong Kong Association for the Study of Liver Diseases 25 25 P =0.030 P =0.033 P=0.026 P=0.007 P =0.012 19% 20 20 The Hong Kong Association for the Study of Liver Diseases 15 15 11.9% 11.5% 11.1% 10 10 6.3% 5.5% 4.7% The Hong Kong Association for the Study of Liver Diseases 4.7% 5 1.2% 0.8% 0 Intraventricular Antepartum Threatened Gestational DM Preterm labour hemorrhage hemorrhage preterm labour at < 34 weeks The Hong Kong Association for the Study of Liver Diseases <37 weeks Multivariate analysis: threatened preterm labour, antepartum hemorrhage and gestational diabetes mellitus The Hong Kong Association for the Study of Liver Diseases Tse KY. etal. J Hepatol. 2005 ; 771-5

The Hong Kong Association for the Study of Liver Diseases The Hong Kong Association for the Study of Liver Diseases Mother to Child Transmission of HBV The Hong Kong Association for the Study of Liver Diseases • Intrauterine • Intrapartum The Hong Kong Association for the Study of Liver Diseases • Postpartum The Hong Kong Association for the Study of Liver Diseases The Hong Kong Association for the Study of Liver Diseases Degli Esposti S. et al. Gastroenterolo Clin North Am. 2011: 355-72. The Hong Kong Association for the Study of Liver Diseases Xu D-Z. et al. J Med Virol. 2002: 20-6.

The Hong Kong Association for the Study of Liver Diseases Intrauterine transmission of HBV The Hong Kong Association for the Study of Liver Diseases % 20 20 HBsAg or HBV DNA positive in neonatal blood within 24 h after births The Hong Kong Association for the Study of Liver Diseases 15 15 The Hong Kong Association for the Study of Liver Diseases 9.8% 10 10 The Hong Kong Association for the Study of Liver Diseases 5 3.7% The Hong Kong Association for the Study of Liver Diseases 0 402 HBsAg +ve mother HBeAg +ve mother The Hong Kong Association for the Study of Liver Diseases Xu DZ. et al. J Med Virol 2002; 67: 20-6.

The Hong Kong Association for the Study of Liver Diseases Risk factors for intrauterine HBV The Hong Kong Association for the Study of Liver Diseases infection The Hong Kong Association for the Study of Liver Diseases • Maternal HBeAg positivity • High maternal HBV DNA The Hong Kong Association for the Study of Liver Diseases • Threatened preterm labor The Hong Kong Association for the Study of Liver Diseases • Threatened abortion The Hong Kong Association for the Study of Liver Diseases Degli Esposti S. et al. Gastroenterolo Clin North Am. 2011: 355-72. Xu D-Z. et al. J Med Virol. 2002: 20-6. The Hong Kong Association for the Study of Liver Diseases

The Hong Kong Association for the Study of Liver Diseases Mother-to-Child Transmission of HBV is associated with high rate of progression to chronic HBV infection The Hong Kong Association for the Study of Liver Diseases 100 % Progression to chronic infection (%) 90 The Hong Kong Association for the Study of Liver Diseases 80 70 The Hong Kong Association for the Study of Liver Diseases 60 50 40 The Hong Kong Association for the Study of Liver Diseases 30 20 10 The Hong Kong Association for the Study of Liver Diseases 0 Infants/Children Newborns Immunocompetent Adults The Hong Kong Association for the Study of Liver Diseases Lok AS, et al. Hepatology 2009;50:661-662; Chen HL, et al. J Infect Dis. 2017;216(suppl_8):S785-S791

The Hong Kong Association for the Study of Liver Diseases Immunoprophylaxis for prevention of MTCT of HBV in infants born to HBeAg-positive Mothers The Hong Kong Association for the Study of Liver Diseases % 100 100 >90% The Hong Kong Association for the Study of Liver Diseases 80 80 MTCT of HBV 60 60 The Hong Kong Association for the Study of Liver Diseases 40 40 26% The Hong Kong Association for the Study of Liver Diseases 20 20 3%-7% 0 No HBIG + HBV vaccine The Hong Kong Association for the Study of Liver Diseases HBIG within 12 h immunoprophylaxis of birth Beasley RP. et al. Lancet 1981; 2. Beasley RP. et al. Hepatology 1983; 3 The Hong Kong Association for the Study of Liver Diseases Beasley RP. et al. Lacet 1983; 2 Lee C. et al. BMJ 2006; 332.

The Hong Kong Association for the Study of Liver Diseases Immunoprophylaxis to prevent MTCT of HBV : meta-analysis The Hong Kong Association for the Study of Liver Diseases Intervention Relative Risk of neonatal The Hong Kong Association for the Study of Liver Diseases HBV infection 0.28 (95% CI 0.2-0.4) HBV vaccine The Hong Kong Association for the Study of Liver Diseases VS Placebo The Hong Kong Association for the Study of Liver Diseases 0.54 (95% CI, 0.41-0.73) HBIG +HBV vaccine VS The Hong Kong Association for the Study of Liver Diseases HBV vaccine Lee C. et al. BMJ 2006; 332: 328-36. The Hong Kong Association for the Study of Liver Diseases