Chinese Medical Journal (Nov 2019)

Unsatisfying antiviral therapeutic effect in patients with mother-to-child transmissed chronic hepatitis B virus infection: a prospective multi-center clinical study

  • Jun Li,
  • Xiao-Qin Dong,
  • Zhao Wu,
  • An-Lin Ma,
  • Shi-Bin Xie,
  • Xu-Qing Zhang,
  • Zhan-Qing Zhang,
  • Da-Zhi Zhang,
  • Wei-Feng Zhao,
  • Guo Zhang,
  • Jun Cheng,
  • Qing Xie,
  • Jun Li,
  • Zhi-Qiang Zou,
  • Ying-Xia Liu,
  • Gui-Qiang Wang,
  • Hong Zhao,
  • Li-Shao Guo,
  • China Hepatitis B Related Fibrosis Assessment Research Group

DOI
https://doi.org/10.1097/CM9.0000000000000522
Journal volume & issue
Vol. 132, no. 22
pp. 2647 – 2656

Abstract

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Abstract. Background:. Few data are available regarding the progression of liver disease and therapeutic efficacy in chronic hepatitis B virus (HBV) carriers infected by mother-to-child transmission (MTCT). This study aimed to investigate these two aspects by comparing the adult chronic HBV carriers in MTCT group with those in horizontal transmission group. Methods:. The 683 adult chronic HBV patients qualified for liver biopsy including 191 with MTCT and 492 with horizontal transmission entered the multi-center prospective study from October 2013 to May 2016. Biopsy results from 217 patients at baseline and 78 weeks post antiviral therapy were collected. Results:. Patients infected by MTCT were more likely to have e antigen positive (68.6% vs. 58.2%, χ2 = –2.491, P = 0.012) than those with horizontal transmission. However, in patients with MTCT, levels of alkaline phosphatase (ALP) (P = 0.031), Fibroscan (P = 0.013), N-terminal propeptide of Type III procollagen (PIIINP) (P = 0.014), and Laminin (LN) (P = 0.006) were high, in contrast to the patients with horizontal transmission for whom the levels of albumin (ALB) (P = 0.041), matrix metalloproteinase-3 (MMP-3) (P = 0.001) were high. The 47.2% of patients with MTCT and 36.8% of those with horizontal transmission had significant liver fibrosis (P = 0.013). Following antiviral therapy for 78 weeks, 21.2% and 38.0% patients with MTCT and horizontal transmission acquired hepatitis B e antigen (HBeAg) clearance, respectively (P = 0.043), and the virological response rates were 54.7% and 74.1% in the MTCT and horizontal groups, respectively (P = 0.005). MTCT was a risk factor for HBeAg clearance and virological response. Conclusion:. Adult patients with MTCT were more prone to severe liver diseases, and the therapeutic efficacy was relatively poor, which underlined the importance of earlier, long-term treatment and interrupting perinatal transmission. Trial Registration:. NCT01962155; https://clinicaltrials.gov.