Observational Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 28, 2015; 21(4): 1261-1267
Published online Jan 28, 2015. doi: 10.3748/wjg.v21.i4.1261
Post-partum reactivation of chronic hepatitis B virus infection among hepatitis B e-antigen-negative women
Ioannis Elefsiniotis, Elena Vezali, Dimitrios Vrachatis, Sofia Hatzianastasiou, Stefanos Pappas, George Farmakidis, Georgia Vrioni, Athanasios Tsakris
Ioannis Elefsiniotis, Elena Vezali, Dimitrios Vrachatis, Sofia Hatzianastasiou, University Department of Internal Medicine-Hepatology Unit, Maternal and Perinatal Hospital “Elena Venizelou”, 11521 Athens, Greece
Stefanos Pappas, George Farmakidis, Department of Obstetrics and Gynecology, Maternal and Perinatal Hospital “Elena Venizelou”, 11521 Athens, Greece
Georgia Vrioni, Athanasios Tsakris, Department of Microbiology, Medical School, University of Athens, 15771 Athens, Greece
Author contributions: Elefsiniotis I designed the study and wrote the draft of the manuscript; Vezali E interpreted the data and finalized the manuscript; Vrachatis D and Hatzianastasiou S performed the research; Pappas S and Farmakidis G analyzed the data; Vrioni G and Tsakris A provided vital reagents and analytical tools.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Elena Vezali, MD, University Department of Internal Medicine-Hepatology Unit, Maternal and Perinatal Hospital “Elena Venizelou”, Elena Venizelou square 2, 11521 Athens, Greece. evezali@otenet.gr
Telephone: +30-210-6427379 Fax: +30-210-6427379
Received: July 5, 2014
Peer-review started: July 5, 2014
First decision: July 21, 2014
Revised: August 20, 2014
Accepted: October 15, 2014
Article in press: October 15, 2014
Published online: January 28, 2015
Processing time: 206 Days and 13 Hours
Abstract

AIM: To investigate the frequency and timing of post-partum chronic hepatitis B virus (HBV) reactivation and identify its pre-partum predictors.

METHODS: Forty-one hepatitis B e antigen (HBeAg)-negative chronic HBV infected pregnant women were prospectively evaluated between the 28th and the 32nd week of gestation. Subjects were re-evaluated at 3-mo intervals during the first post-partum year and every 6 mo during the following years. HBV DNA was determined using real-time reverse transcription polymerase chain reaction (Cobas TaqMan HBV Test) with a lower detection limit of 8 IU/mL. Post-partum reactivation (PPR) was defined as abnormal alanine aminotransaminase (ALT) levels and HBV DNA above 2000 IU/mL.

RESULTS: Fourteen out of 41 women (34.1%) had pre-partum HBV DNA levels > 2000 IU/mL, 18 (43.9%) had levels < 2000 IU/mL and 9 (21.9%) had undetectable levels. Fourteen women were lost to follow-up (failure to return). PPR occurred in 8 of the 27 (29.6%) women evaluated, all within the first 6 mo after delivery (5 at month 3; 3 at month 6). Five of the 6 (83.3%) women with pre-partum HBV DNA > 10000 IU/mL exhibited PPR compared with 3 of the 21 (14.3%) women with HBV DNA < 10000 IU/mL (two with HBV DNA > 2000 and the third with HBV DNA of 1850 IU/mL), P = 0.004. An HBV DNA level ≥ 10000 IU/mL independently predicted post-partum HBV infection reactivation (OR = 57.02, P = 0.033). Mean pre-partum ALT levels presented a non-significant increase in PPR cases (47.3 IU/L vs 22.2 IU/L, respectively, P = 0.094).

CONCLUSION: In the present study, PPR occurred in approximately 30% of HBeAg-negative pregnant women; all events were observed during the first semester after delivery. Pre-partum HBV DNA level > 10000 IU/mL predicted PPR.

Keywords: Hepatitis B; Pregnancy; Reactivation; Post-Partum; Hepatitis B virus-DNA

Core tip: According to our prospective study, the post-partum reactivation of chronic hepatitis B occurs in approximately 30% of hepatitis B e antigen-negative women; all cases are observed during the first 6 mo after delivery. Among demographic, hematological, biochemical and viral characteristics, the only pre-partum parameter predictive for post-partum hepatitis B virus reactivation is whether the maternal viral load is greater than 10000 IU/mL between the 28th and the 32nd week of gestation.