Real-world clinical and virological outcomes in a retrospective multiethnic cohort study of 341 untreated and tenofovir disoproxil fumarate-treated chronic hepatitis B pregnant patients in North America
Golasa Samadi Kochaksaraei
Division of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
Search for more papers by this authorEliana Castillo
Medical Disorders in Pregnancy, Division of Internal Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
Search for more papers by this authorMatthew D. Sadler
Division of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
Search for more papers by this authorCynthia H.-T. Seow
Division of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
Search for more papers by this authorHerman W. Barkema
Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
Department of Production Animal Health, Faculty of Veterinary Medicine, University of Calgary, Calgary, AB, Canada
Search for more papers by this authorSteven R. Martin
Department of Paediatrics, Alberta Children’s Hospital, Calgary, AB, Canada
Search for more papers by this authorHeidi Israelson
Division of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
Search for more papers by this authorJacqueline Pinto
Division of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
Search for more papers by this authorSarah Williams
Division of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
Search for more papers by this authorAIexander I. Aspinall
Division of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
Search for more papers by this authorLaura M. Stinton
Division of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
Search for more papers by this authorMeredith A. Borman
Division of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
Search for more papers by this authorKelly W. Burak
Division of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
Search for more papers by this authorMark G. Swain
Division of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
Search for more papers by this authorStephen E. Congly
Division of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
Search for more papers by this authorSamuel S. Lee
Division of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
Search for more papers by this authorCorresponding Author
Abdel Aziz Shaheen
Division of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
Correspondence
Abdel Aziz Shaheen and Carla S. Coffin, Liver Unit, Division of Gastroenterology and Hepatology, Department of Medicine, Cumming School of Medicine, University of Calgary, TRW 6D21, 3280 Hospital Drive N.W., Calgary, Alberta, Canada, T2N 4Z6.
Emails: [email protected]; [email protected]
Search for more papers by this authorCorresponding Author
Carla S. Coffin
Division of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
Department of Microbiology, Immunology and Infectious Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
Correspondence
Abdel Aziz Shaheen and Carla S. Coffin, Liver Unit, Division of Gastroenterology and Hepatology, Department of Medicine, Cumming School of Medicine, University of Calgary, TRW 6D21, 3280 Hospital Drive N.W., Calgary, Alberta, Canada, T2N 4Z6.
Emails: [email protected]; [email protected]
Search for more papers by this authorGolasa Samadi Kochaksaraei
Division of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
Search for more papers by this authorEliana Castillo
Medical Disorders in Pregnancy, Division of Internal Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
Search for more papers by this authorMatthew D. Sadler
Division of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
Search for more papers by this authorCynthia H.-T. Seow
Division of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
Search for more papers by this authorHerman W. Barkema
Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
Department of Production Animal Health, Faculty of Veterinary Medicine, University of Calgary, Calgary, AB, Canada
Search for more papers by this authorSteven R. Martin
Department of Paediatrics, Alberta Children’s Hospital, Calgary, AB, Canada
Search for more papers by this authorHeidi Israelson
Division of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
Search for more papers by this authorJacqueline Pinto
Division of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
Search for more papers by this authorSarah Williams
Division of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
Search for more papers by this authorAIexander I. Aspinall
Division of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
Search for more papers by this authorLaura M. Stinton
Division of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
Search for more papers by this authorMeredith A. Borman
Division of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
Search for more papers by this authorKelly W. Burak
Division of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
Search for more papers by this authorMark G. Swain
Division of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
Search for more papers by this authorStephen E. Congly
Division of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
Search for more papers by this authorSamuel S. Lee
Division of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
Search for more papers by this authorCorresponding Author
Abdel Aziz Shaheen
Division of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
Correspondence
Abdel Aziz Shaheen and Carla S. Coffin, Liver Unit, Division of Gastroenterology and Hepatology, Department of Medicine, Cumming School of Medicine, University of Calgary, TRW 6D21, 3280 Hospital Drive N.W., Calgary, Alberta, Canada, T2N 4Z6.
Emails: [email protected]; [email protected]
Search for more papers by this authorCorresponding Author
Carla S. Coffin
Division of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
Department of Microbiology, Immunology and Infectious Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
Correspondence
Abdel Aziz Shaheen and Carla S. Coffin, Liver Unit, Division of Gastroenterology and Hepatology, Department of Medicine, Cumming School of Medicine, University of Calgary, TRW 6D21, 3280 Hospital Drive N.W., Calgary, Alberta, Canada, T2N 4Z6.
Emails: [email protected]; [email protected]
Search for more papers by this authorSummary
Background
There are limited long-term data on outcomes of chronic hepatitis B (CHB) in untreated and tenofovir disoproxil fumarate (TDF)-treated women during pregnancy.
Aims
To assess clinical outcomes in a multiethnic cohort of patients during pregnancy and post-partum in a low HBV endemic region.
Methods
Retrospective real-world study of women with CHB (treated or untreated with TDF) from 2011 to 2019; data including ALT, HBV DNA, HBeAg and liver stiffness measurement were collected during pregnancy and post-partum.
Results
In 341 women (446 pregnancies) followed for a median of 33 months (IQR: 26.7-39.5) post-partum, 19% (65/341) received TDF (11 initiated pre-pregnancy, 53 for mother-to-child transmission (MTCT) prevention). During follow-up, 72/341 had subsequent pregnancy, including 18/53 on TDF for MTCT risk, of whom 7/18 were re-treated. In all TDF-treated women, HBV DNA declined but rebounded after TDF withdrawal (median baseline, near birth and early follow-up levels were 7.2, 3.0 and 5.5 log IU/mL respectively [P < 0.01]). In HBeAg+ patients (65/341) ALT flares were more common (P = 0.03), especially for those who stopped TDF post-partum, requiring re-treatment in 21% (11/53). In comparison, 54% (116/215) of untreated women had a post-partum ALT flare; one with fulminant hepatitis underwent transplant 13 months post-partum. HBsAg clearance occurred in 2.6% (9/341, 3/9 HBeAg+, 2/9 TDF treated) at median 30 months (IQR: 23-40) and 37% (24/65) of HBeAg+ patients had HBeAg loss at median 17 months (IQR: 12-26) post-partum.
Conclusions
Post-partum ALT flares were common, especially after TDF withdrawal. Overall, 37% achieved HBeAg clearance and 2.9% had HBsAg loss during long-term follow-up.
Supporting Information
| Filename | Description |
|---|---|
| apt16123-sup-0001-FigS1-S3.docxWord document, 119.3 KB | Fig S1-S3 |
| apt16123-sup-0002-TableS1-S7.docxWord document, 33.1 KB | Table S1-S7 |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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