Hepatitis B Virus HBV Variants in Untreated and Tenofovir Treated Chronic Hepatitis B CHB Patients during Pregnancy and Post-Partum Follow-UpReportar como inadecuado




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Background

Chronic hepatitis B CHB is a dynamic disease that may be affected by immune changes in pregnancy. Guidelines suggest consideration of nucleos-tide analogs NA, i.e., tenofovir, TDF in highly viremic mothers to reduce vertical transmission risk. HBV variability affects CHB outcome, but little is known about HBV genetic changes in pregnancy due to immune or NA selection.

Objectives

To evaluate HBV diversity in NA treated or untreated pregnant vs. post-partum CHB carriers.

Study Design

In plasma collected from 21 mothers 7 matching pre-post-partum, HBV serological tests, genotype and viral load were assayed. The HBV pre-surface S -S overlapping polymerase P N = 20, pre-core C -C N = 11 and-or full genome PCR amplicons N = 3 underwent clonal sequence analysis.

Results

The median age was 31 y, 71% Asian, 68% genotype B or C, 33% HBV eAg+, 5 received TDF median HBV DNA 8.5 log IU-ml. In untreated mothers, median antepartum vs. post-partum ALT was 21 vs. 24 U-L and HBV DNA was 2.7 vs. 2.4 log10 IU-ml. ALT and-or HBV DNA flares occurred during pregnant and-or post-partum period in 47% 10-21. Clonal sequencing antepartum showed the presence of minor -a determinant- and-or vaccine escape mutants VEM but drug resistant variants were infrequent. Analysis of pregnant vs. post-partum samples showed different HBV variants and viral diversity.

Conclusions

Differences in immune and-or by NA selective pressures during pregnancy may affect HBV evolution during pregnancy. The presence of minor VEM warrant infant follow-up.



Autor: Boris Virine, Carla Osiowy, Shan Gao, Tong Wang, Eliana Castillo, Steven R. Martin, Samuel S. Lee, Kimberley Simmonds, Guido van

Fuente: http://plos.srce.hr/



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