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• W2885228783 abstract "To the Editor: With great satisfaction, we read the April 2018 American Association for the Study of Liver Diseases (AASLD) guidelines for the management of chronic hepatitis B propose that pregnant women with hepatitis B virus (HBV) receive tenofovir in the third trimester, for viral loads greater than 200,000 IU/mL.1 Surprisingly, the first double‐blinded, randomized, controlled trial on this subject, released in the March 8 issue of the New England Journal of Medicine, found no significant difference between fetal viral loads of a group of 147 women who received tenofovir beginning at 28 weeks and those of a control group who did not. The researchers concluded that there was no benefit to prescribing tenofovir in the third trimester of pregnancy.2 These results contrast with the thinking that the AASLD has carefully substantiated and cultivated in the hepatology community in recent years. The conclusion reached by the researchers of this study is counterintuitive, because 3 patients in their placebo group developed hepatitis B, whereas none in the treated group became infected. It is noteworthy that the mothers of all 3 infected infants in the treated group had HBV‐DNA levels of more than 7.8 log10 IU/mL. Such high viral loads may well be refractory to antiviral rescue during pregnancy. However, there are certainly a substantial number of mothers with viral loads somewhere between 200,000 and 1 million who can benefit from tenofovir. This particular trial simply cannot define the most precise group of potential beneficiaries. A randomized, open‐label trial published in 2016 studied 200 mothers with viral loads greater than 200,000 IU/mL and concluded that the rate of mother‐to‐child transmission was lower among those who received tenofovir disoproxil fumarate therapy than among those who received care without antiviral therapy. The researchers endorsed the use of tenofovir as outlined in the recent AASLD guidelines. We are not told viral loads of the mothers of tenofovir failures in this 2016 study, but it is possible that these mothers had initial viral loads that were several orders of magnitude greater than other viremic mothers who may have responded.3 It is therefore not reasonable to conclude from the March 2018 controlled trial that tenofovir is of no benefit to mothers with viral loads greater than 200,000 IU/mL. There may be, however, a higher threshold beyond which tenofovir will no longer do the job. For the time being, the new AASLD guidelines must be followed. Perhaps, in the future, there will be a more potent antiviral agent that can eradicate much higher viral loads during pregnancy. Potential conflict of interest Nothing to report." @default.
• W2885228783 created "2018-08-22" @default.
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• W2885228783 date "2018-10-01" @default.
• W2885228783 modified "2023-09-26" @default.
• W2885228783 title "The Efficacy of Tenofivir to Prevent Perinatal Transmission in Chronic Hepatitis B Mothers. A Clinical Perspective" @default.
• W2885228783 cites W2442031947 @default.
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• W2885228783 doi "https://doi.org/10.1002/hep.30138" @default.
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