Review
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World J Gastroenterol. Oct 28, 2010; 16(40): 5042-5046
Published online Oct 28, 2010. doi: 10.3748/wjg.v16.i40.5042
Breastfeeding and chronic HBV infection: Clinical and social implications
Mihaela Petrova, Victor Kamburov
Mihaela Petrova, Clinic of Gastroenterology, Ministry of Interior, Sofia 1606, Bulgaria
Victor Kamburov, Department of Gastroenterology, First Multi Profile Hospital for Active Treatment, Sofia 1142, Bulgaria
Author contributions: Petrova M wrote the first draft of the manuscript; Kamburov V contributed to the subsequent drafts and equally to the general idea and structure of the manuscript.
Correspondence to: Dr. Mihaela Petrova, PhD, Clinic of Gastroenterology, Medical Institute, MI, Sofia 1606, 79 “Skobelev” Blvd., Bulgaria. mpetrova@gmail.com
Telephone: +359-2-9821356 Fax: +359-2-8964880
Received: April 1, 2010
Revised: June 22, 2010
Accepted: June 29, 2010
Published online: October 28, 2010
Abstract

Mother-to-child transmission of hepatitis B virus (HBV) is among the most important causes of chronic HBV infection and is the commonest mode of transmission worldwide. Currently, the presence of HBsAg, HBeAg and HBV DNA in breast milk is confirmed. Several studies have reported that breastfeeding carries no additional risk that might lead to vertical transmission. Beyond some limitations, the surveys have not demonstrated any differences in HBV transmission rate regarding feeding practices in early childhood. Promotion of breastfeeding is substantial, especially for low-income individuals and regions with uncertain, unfeasible, and unsafe water supplies. Lactoferrin, minimal inflammation or activation within the infant gut during exclusive breastfeeding, and nonspecific biological molecules in the milk are identified as major factors of breast-milk defense. This review discusses preemptive antiviral therapy during pregnancy and lactation. Long-term follow up of breast-milk HBV concentrations and correlation with serum viral load; nucleos(t)ide analogue concentrations in breast milk in HBV-positive mothers in the setting of chronic HBV infection; safety of antiviral therapy during pregnancy and lactation; and the difference in viral load in the milk in exclusive or non-exclusive breastfeeding are still open questions. The paper reviews the current data and outlines the course of further investigation into this often underestimated issue.

Keywords: Breastfeeding; Lamivudine; Tenofovir; Hepatitis B virus; Chronic hepatitis B