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A hepatitis B immunuglobulin-free strategy for prevention of mother-to-child hepatitis B transmission is feasible and highly effective in a resource-limited setting if tenofovir is given for at least four weeks prior to delivery, a team of French and Cambodian researchers reported earlier this month at the Conference on Retroviruses and Opportunistic Infections (CROI 2022).
Reducing mother-to-child transmission of hepatitis B is a critical element in efforts to eliminate hepatitis B.
Perinatal prophylaxis against mother-to-child transmission of hepatitis B consists of infant vaccination against hepatitis B within 24 hours of birth, along with infusions of hepatitis B immunoglobulin G (HBIgG) for the infant after birth, to provide antibody protection until the infant’s own response begins to produce antibodies after vaccination.
For mothers, tenofovir treatment during the last trimester of pregnancy is recommended if the hepatitis B DNA level is above 5.3 log 10 IU/ml, and/or the mother is hepatitis B ‘e’ antigen positive (HBeAg+) (a sign of viral replication).
But for lower-income countries like Cambodia, this strategy can be challenging to implement due to limited health system resources. Lack of access to HBIgG and HBV DNA testing prevents timely provision of either HBIgG or tenofovir.
Immunoglobulin-free alternative regimens are needed, as well as a point-of-care rapid test for hepatitis B ‘e’ antigen as an alternative to HBV DNA quantification.
The TA-PROHM study was designed to test a strategy that could address these gaps. Pregnant women were tested for hepatitis B ‘e’ antigen, offered tenofovir treatment from week 24 of pregnancy if they tested positive or had an ALT measurement above 40 IU/ml, and infants received a three-dose hepatitis B vaccine dose after delivery.
The study findings showed that the combined intervention of rapid testing for hepatitis B ‘e’ antigen, tenofovir treatment for mothers initiated at least four weeks prior to delivery and infant hepatitis B vaccination prevented mother-to-child transmission of hepatitis B. All infants who tested positive for hepatitis B surface antigen were born to mothers who initiated tenofovir less than four weeks prior to delivery.
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