2023-03-01·European review for medical and pharmacological sciences
Is the use of Tenofovir Dipivoxil fumarate effective and safe in preventing vertical transmission in pregnant women with chronic HBV with high viral load?
作者: H Aladag ; M Aladag
In our country, transmission from mother to baby is the most common form of transmission of viral hepatitis B. A high viral load in the mother and HBeAg positivity pose the greatest risk of transmission from mother to baby. The best way to prevent this is to try to eliminate the viral load in the mother by using a strong antiviral such as prenatal TDF in mothers with a high viral load during pregnancy. This study aimed to evaluate the efficacy and safety of TDF in pregnant women with high viral load.
PATIENTS AND METHODS:
Seventy patients with hepatitis B e-antigen positive and negative were included in the retrospective study conducted in our clinic. In 35 cases, pregnant women with HBeAg (+) positive chronic HBV and HBV-DNA levels of 107 copies/mL were between 18 and 27 weeks of pregnancy. The pregnant women took 300 mg of TDF per day. There were 35 untreated HBeAg-negative, chronic HBV patients in the control group. Babies born to HBeAg-positive and HBeAg-negative mothers are given an initial dose of 200 IU of hepatitis B immune globulin (HBIG) and 20 g of recombinant hepatitis B vaccine in the first 12 hours after birth, followed by 4, 8, and 24 weeks. HBsAg and HBV-DNA findings were examined in newborn serum 28 weeks after birth.
Postpartum 28 weeks, none of the babies born to HBeAg-positive mothers treated with TDF had HBsAg positivity, while 3.5% of babies born to HBeAg-negative mothers and not treated with TDF had HBsAg positivity and immunoprophylaxis failure. There was no statistically significant difference between the treatment and control groups regarding maternal height, weight, gestational age, or congenital malformations (p<0.05). There was no significant difference between the side effects seen in mothers. In the examination performed at the 28th week postpartum, a statistically significant decrease in HBV-DNA levels was observed in mothers who received TDF treatment compared to those who did not (88.5%) (p<0.05). In 31 of the 35 patients receiving TDF treatment, ALT was reported to be normalized in 25 of the 35 patients who did not receive TDF treatment (p<0.05).
It has been observed that the use of TDF, which has a strong efficacy and high barrier, in the second and/or third trimester of pregnancy reduces transmission rates without causing side effects in both the mother and the newborn, thereby preventing vertical transmission of viral hepatitis B from the mother to child.
2022-11-10·BMC infectious diseases
Determinants of therapy failure among adults on first-line antiretroviral therapy in Asmara, Eritrea: a multicenter retrospective matched case-control study.
Information on treatment failure (TF) in People living with HIV in a data-poor setting is necessary to counter the epidemic of TF with first-line combined antiretroviral therapies (cART) in sub-Saharan Africa (SSA). In this study, we examined the risk factors associated with TF in Asmara, Eritrea from 2001 to 2020.
A multicenter, retrospective 1:2 matched (by age and gender) case-control study was conducted in four major hospitals in Asmara, Eritrea on adults aged ≥ 18 years who were on treatment for at least 6 months. Cases were patients who fulfills at least one of the WHO therapy failure criterion during the study period. Controls were randomly selected patients on first-line treatment and plasma viral load < 1000 copies/ml in their latest follow-up measurement. Multivariable logistic regression analysis was conducted to identify risk factors for TF. All P-values were 2-sided and the level of significance was set at P < 0.05 for all analyses.
Of the 1068 participants (356 cases; 712 controls), 585 (54.7%) were females. The median age at treatment initiation was 46 years [interquartile range (IQR): 39-51]. Median time to combined antiretroviral therapy (cART) failure was 37 months (IQR = 24-47). In the multivariate analysis, factors associated with increased likelihood of TF included initial nucleoside reverse transcriptase inhibitors (NRTI) backbone (Zidovudine + Lamivudine (AZT + 3TC): adjusted odds ratio (aOR) = 2.70, 95% Confidence interval (CI): 1.65-4.41, P-value < 0.001), (Abacavir + lamivudine (ABC + 3TC): aOR = 4.73, 95%CI: 1.18-18.92, P-value = 0.028], and (Stavudine + Lamivudine (D4T + 3TC): aOR = 5.00; 95% CI: 3.03-8.20, P-value < 0.001) in comparison to Emtricitabine and Tenofovir diproxil fumarate (FTC + TDF). Additional associations included prior exposure to cART (aOR = 2.28, 95%CI: 1.35-3.86; P- value = 0.002), record of sub-optimal drug adherence (aOR = 3.08, 95%CI: 2.22-4.28; P < 0.001), ambulatory/bedridden at presentation (aOR = 1.61, 95%CI: 1.12-4.28; P-value = 0.010), presence of comorbidities (aOR = 2.37; 95%CI: 1.36-4.10, P-value = 0.002), duration of cART (< 5 years: aOR: 5.90; 95% CI: 3.95-8.73, P-value < 0.001), and use of SMX-TMP prophylaxis (aOR = 2.00, 95%CI, 1.44-2.78, P-value < 0.001).
Our findings underscore the importance of optimizing cART adherence, diversification of cART regimens, and interventions directed at enhancing early HIV diagnosis, prompt initiations of treatment, and improved patient-focused monitoring of treatment response.
2022-04-20·Zhonghua gan zang bing za zhi = Zhonghua ganzangbing zazhi = Chinese journal of hepatology
[A study of the effectiveness of nucleos(t)ide analogues in the treatment of HBeAg- positive chronic hepatitis B with normal alanine aminotransferase and high level of HBV DNA].
作者: F D Wang ; J Zhou ; D M Zhang ; M L Wang ; Y C Tao ; D B Wu ; H Tang ; E Q Chen
Objective: To investigate the effectiveness of nucleos(t)ide analogues in the treatment of HBeAg-positive chronic hepatitis B with normal alanine aminotransferase and high level of HBV DNA. Methods: Treatment-naïve chronic hepatitis B patients who were followed up at the Center of Infectious Diseases, West China Hospital of Sichuan University from January 2019 to January 2020 were selected as subjects. Demographic characteristics, the results of laboratory examination before treatment and one year after treatment were retrospectively collected. Patients were divided into tenofovir dipivoxil (TDF) and propofol fumurate tenofovir (TAF) treatment group according to different types of medication. The changes of serum HBV DNA level, HBeAg serological conversion and HBsAg quantitative level were analyzed and compared between the two groups. Results: A total of 38 cases were enrolled. Among them, there were 16 and 22 cases in the TDF and TAF group, respectively. There was no statistically significant difference in demographic characteristics, baseline HBV DNA levels and HBsAg quantitative levels between the two groups. Virological response was achieved in 60.5% (23/38) of patients after one year of antiviral therapy. Serum HBV DNA levels below the lower limit of detection [68.2% (15/22) vs. 50.0% (8/16), P=0.258] and higher HBeAg seroconversion rate [18.2%] (4/22) vs. 6.3% (1/16), P=0.374] was obtained in TAF than TDF group; however, there was no statistically significant differences between the two. Serum HBsAg quantitative level was significantly reduced with TDF and TAF treatment. In addition, alanine aminotransferase elevation was reduced in TAF than TDF treated group. Multivariate logistic regression analysis showed that patient age was an independent predictor of a virological response to antiviral therapy. Conclusion: HBeAg-positive CHB patients with normal alanine aminotransferase, and high HBV DNA level can obtain better curative effect after TDF and TAF treatment.