Beena Guhan1, Smitha Dasarahalli Sadananda2
Hepatitis B infection is most commonly acquired through perinatal or horizontal transmission. The combined immunity of hepatitis B vaccine and high-titre hepatitis B immunoglobulin HBIG has excellent efficacies in blocking the maternal-foetal transmission of hepatitis B virus. This study was aimed to stop such transmission from mothers with high hepatitis B virus DNA viral loads by giving them lamivudine antenatally.
The aim of the study is to study the effect of lamivudine treatment to decrease hepatitis B virus DNA viral load in the third trimester in hepatitis B surface antigen pregnant positive women and its effect on vertical transmission of hepatitis B.
MATERIALS AND METHODS
The hepatitis B surface antigen positive pregnant women attending the department who satisfied the inclusion criteria were selected for this prospective case-control study of 30 in each group. Hepatitis B viral DNA load was seen at 28 weeks in both groups and lamivudine started at 32 weeks in the case group. Both groups were followed up antenatally, intrapartum and postpartum till 1 month and babies till 6 months. DNA viral load 1 month postpartum for the mother and hepatitis B surface antigen positivity observed in the babies till the age of 6months.
The prevalence of hepatitis B infection was more in the age group of 25-30 years. A high transmission rate of 36.1% was observed in hepatitis B envelope antigen positive mothers. There was a significant fall in the DNA viral load in the range of 10 log 4 to 10 log 6 in the case group, p value 0.000. 48.3% hepatitis B envelope antigen positive mothers in the case group became hepatitis B envelope antigen negative at the end of the study. 46.7% babies in the control group versus only 16.7% in the case group were hepatitis B surface antigen positive at the end.
Lamivudine treatment of highly viraemic hepatitis B surface antigen positive women during the final months of pregnancy has reduced the risk of perinatal transmission of hepatitis B virus combined with hepatitis B virus vaccination plus hepatitis B immunoglobulin. Hepatitis B envelope antigen positivity, a condition which is an independent predictor of foetal transmission, seroconverted to a negative status with lamivudine treatment, foetal transmission also decreased appreciably.
Lamivudine, Hepatitis B Positive Pregnancy, Viral Load.