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在服用TAF且病毒载量异常高的母亲中垂直传播

Huaibin Zou¹, Liying Zhu², Lihua Cao³

¹Fourth Department of Liver Disease, Beijing Youan Hospital, Capital Medical University, Beijing, China.

Journal of viral hepatitis

|February 15, 2025

概括

诺福维尔阿拉芬胺 (TAF) 治疗显示,在病毒载量非常高的母亲中,乙型肝炎病毒 (HBV) 的母婴传播率为2%. 建议将TAF治疗延长至12周以改善预防,对母亲或婴儿没有观察到安全问题.

科学领域:

肝病学和病毒学.
孕产妇和胎儿医学孕产妇和胎儿医学
药理学和治疗学药理学和治疗学

背景情况:

已发表的关于特诺福维尔阿拉芬胺 (TAF) 用于预防乙型肝炎病毒 (HBV) 母婴传播 (MTCT) 的研究通常涉及病毒载量约为7 log 10 IU/mL的母亲.
在具有异常高HBVDNA水平 (>2,000,000 IU/mL) 的母亲中TAF的疗效仍然不太清楚.

研究的目的:

评估TAF在预防具有极高病毒载量 (>2,000,000 IU/mL) 的母亲的HBVMTCT中的有效性和安全性.
评估母亲在分娩时的HBVDNA抑制以及婴儿中先天性异常和HBsAg阳性的发生率.

主要方法:

预期招募120名HBeAg阳性母亲,HBVDNA>2,000,000 IU/mL,在怀孕26-28周之间开始接受TAF.
婴儿接受了标准的免疫预防;随访延长至分娩后28周.
主要终点:MTCT速率和先天性异常;次要结果:母体病毒抑制和安全.

主要成果:

在93.3%的母亲中,通过分娩实现了母性HBVDNA抑制 (<20万 IU/mL).
在产后28周,整体MTCT率为2% (2/121名婴儿).
一名婴儿 (0.8%) 患有先天性形;9.9%的婴儿出生时检测出HBsAg阳性. 没有报告严重的不良事件.

结论:

在病毒载量非常高的母亲中,TAF治疗是有效和安全的预防HBV MTCT,通过婴儿免疫预防实现2%的传播率.
产后阿兰氨基转移酶 (ALT) 爆发和病毒反弹在TAF停止后发生在很大比例的母亲身上.
在极高病毒负载的母亲中,将TAF治疗持续时间延长到产后12周以后,可能进一步改善MTCT预防.

关键词:

抗病毒疗法是一种抗病毒疗法.免疫预防免疫预防免疫预防母婴母婴传播的情况.预防预防预防

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