Naslov
Immune Reconstitution in Pregnancy and Chronic Hepatitis B – Is Post-Delivery Flare Associated with Evolution in HBV DNA Viral Replication and HBsAg Levels in Untreated Patients Post Partum?

Autori
Carey, I ; McLeod, AM ; Bruce, M ; Horner, M ; Bowyer, T ; Oakes, K ; Mrzljak, Anna ; Basuroy, B ; Verma, S ; Agarwal, K

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, znanstveni

Izvornik
Journal of Hepatology / Elsevier - : European Association for the Study of the Liver., 2016

Skup
51st annual meeting of the European Association for the Study of the Liver

Mjesto i datum
Barcelona, Španjolska, 2016

Vrsta sudjelovanja
Poster

Vrsta recenzije
Međunarodna recenzija

Ključne riječi
chronic hepatitis B, pregnancy

Sažetak
Background and Aims: Pregnancy represents a unique challenge for the immune system. In our pilot study, post-delivery ALT flares were present in 20% chronic HBV (CHB) patients and associated with HBeAg + status, high HBV DNA (>10, 000 IU/mL) at 2nd pregnancy trimester. ALT flares are linked with the restoration of immune system post-delivery although the impact on HBV replication/viral control is not clear. Aim: In this cross-sectional, single centre study, we compared changes in HBV DNA viral load, HBeAg status and HBsAg levels during pregnancy (2nd trimester) and shortly post-delivery in CHB untreated patients according to presence/absence of ALT postdelivery flares and study their impact on post-delivery decline in HBV DNA and HBsAg levels. Methods: Patients: 238 CHB untreated patients (median age 32 years) were assessed at 2nd pregnancy trimester. No transmission to infant occurred in 190 mothers followed for more than 12 months post-delivery. None of patients required antiviral therapy. Methods: Plasma HBeAg, HBsAg, and HBV DNA levels were measured by Abbott ARCHITECT® and real-time TaqMan PCR assays at 2nd pregnancy trimester and 1st post- pregnancy visit (median 48 days). The results were compared between time-points and accoding to presence/absence of post- delivery ALT flare (ALT > 40IU/L and twofold pregnancy level). Results: 47 patients (19.7%) had post- delivery flares. Pregnancy HBsAg levels were similar in flare and no flare patients (3.6 vs. 3.61 log10 IU/mL). 53 (22%) patients had low pregnancy HBsAg (<1000 IU/mL) and this was linked with lower frequency of flares 9% than in HBsAg > 1000 IU/mL group (23%, p = 0.03). Post- delivery HBsAg loss occurred in 6 (2.5%) patients (all with low HBsAg) and only 1 patient had flare. HBsAg decline >0.5 log from pregnancy level was only seen in low HBsAg patients without flare. HBeAg loss ocurred in 3 out of 5 HBeAg + patients, all without flare. Pregnancy HBV DNA was higher in flare than no flare patients (2.87 vs. 2.27 log10IU/mL, p = 0.01), but was similar at post-delivery (2.68 vs. 2.47 log10 IU/mL, p = 0.07). Post-delivery HBV DNA decline >0.5 log from pregnancy level was more frequent in flare than no flare patients (38% vs. 15%, p = 0.04). Conclusions: Post-delivery ALT flares were more frequent in patients with sharper decline of post-pregnancy HBV DNA, perhaps reflecting tighter immune control. In contrast, post- pregnancy HBsAg decline/loss was not linked with post-delivery flares and occurred more frequently in patients with low pregnancy HBsAg (<1000 IU/mL).

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

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