Study On The Efficacy Of Telbivudine/tenofovir In Blocking Mother-to-child Transmission Of HBV And Safety After Drug Withdrawl

Objective HBV is prevalent in China.The positive rate of HBs Ag(hepatitis B surface antigen)is 7.18% in people under 59,and approximately 93 million people in China are infected with HBV.HBV infection is harmful to human,some of which can progress to cirrhosis and hepatocellular carcinoma.In the past 20 years,with the popularization of HBV vaccination and active immunization in China,the prevalence of HBs Ag in people under 29 has decreased significantly,while about 5% of newborns still have HBV infection.In HBV epidemic areas,MTCT(mother-to-child transmission)is the main route of HBV infection.The rate of MTCT is up to 80%~90% in pregnant women with HBV DNA >2 × 106 IU/m L.In recent years,pregnant women with high viral loads have been treated with lamivudine,telbivudine,or tenofovir disoproxil in the second and third trimester to reduce HBV DNA level,and further inhibit MTCT of HBV.A large number of studies have shown the effectiveness of mentioned antiviral drugs for the inhibition of MTCT,but there are few studies on the safty of pregnant women after drug withdrawal in postpartum.With the opening of China's second-child policy,With the opening of China's second-child policy,the issue of mother-to-child transmission of HBV has received more attention from clinicians and parents.several guidelines for postnatal drug withdrawal are not the same,and there is no definitive conclusion among the existing understanding of the liver function and virological changes after discontinouation in HBV mothers.The current understanding of liver function and virological changes after the withdrawal of labor differ greatly.This article aims to discuss the efficacy of tebivudine/tenofovir in blocking mother-to-infant transmission,and follow up biochemical indicators and virologic markers of HBV women after discontinuation of the drug,to discuss the safety and related risk factors after drug withdrawal.Methods We choose 155 medical records from Shenzhen Third Peo Ple's Hos Pital between January 2015 to June 2017,all of the selected records were HBe Ag positive and HBV DNA>2×106IU/ml.The subjects included in the study were divided into three groups according to medication taken or not,nucleoside drugs were taken as group A(control group);telbivudine was taken as group B1(treatment group)from 24 to 28 weeks of gestation;24-28 weeks' gestation.Tenofovir was taken as group B2(treatment group).Pregnant women of B1 and B2,discontinued Ld T/TDF on the day of delivery.Collection includes: basic data,24-28 weeks,4 weeks after administration,before delivery,and ALT levels after delivery(discontinued),HBV DNA,HBV serological markers,creatinine value(B1 group contains CK value)Whether there are major adverse events;newborn sex,HBs Ag after complete whole HBV vaccination,,and whether the fetus has congenital diseases.Results The baseline of the 3 groups were comparable(1)The ALT in every groups were compared at the baseline,0-12 weeks postpartum,and 12-28 weeks postpartum,(P=0.006,0.001,0.001,respectively).ALT flare was concentrated in 0-12 weeks after delivery,and there was no statistical difference between the three groups.Among the pregnant women with elevated ALT at 12-28 weeks postpartum,the ALT levels after discontinuation in B1,B2 group patients were higher than those in the group A(P = 0.024,0.041,respectively);12-28 weeks after discontinuation of the pregnant women in the TDF group.,the decrease rate of ALT was slower than that of Ld T group(P<0.05).(2)In group A,there was a positive correlation between ALT abnormalities and ALT levels before delivery from 0 to 28 weeks postpartum(rs=0.447,P=0.013).(3)B1 and B2 groups quickly rebounded after drug withdrawal and returned to baseline levels 12 weeks postpartum.(4)Three groups patients did not find creatinine,urea nitrogen,and creatine kinase significantly elevated from pregnancy to 28 weeks postpartum.Two patients developed mild jaundice,no muscle pain,persistent rash,and multiple urination.(5)The positive rates of HBs Ag in the newborns of A,B1,and B2 groups were 5%,0,and 0,respectively,P<0.001,and MTCT rate in group A was significantly higher than that in groups B1 and B2.Conclusion1.High viral load HBV women taking Ld T/TDF from 24-28 weeks of gestation can effectively block HBV mother-to-child transmission.The efficacy of Ld T and TDF block HBV mother-to-child blockade equally.2.Whether antiviral during pregnancy or not,elevated transaminase levels can occur postpartum,concentrating within 12 weeks postpartum,and there is no statistical difference in frequency or degree.3.Within 12 weeks after discontinuation,the viral load returned to pre-drug level.4.From the time from pregnancy to 28 weeks after delivery,no significant increase in CK,Cr,BUN,no severe adverse events,no progression to cirrhosis or liver failure,but high viral load of HBV pregnant women in postpartum needs to be followed up for longer.