Unsatisfying antiviral therapeutic effect in patients with mother-tochild 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

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

Author: Jun LI ¹ ; Xiao-Qin DONG ² ; Zhao WU ¹ ; An-Lin MA ³ ; Shi-Bin XIE ⁴ ; Xu-Qing ZHANG ⁵ ; Zhan-Qing ZHANG ⁶ ; Da-Zhi ZHANG ⁷ ; Wei-Feng ZHAO ⁸ ; Guo ZHANG ⁹ ; Jun CHENG ¹⁰ ; Qing XIE ¹¹ ; Jun LI ¹² ; Zhi-Qiang ZOU ¹³ ; Ying-Xia LIU ¹⁴ ; Gui-Qiang WANG ^{1
,

15
,

16} ; Hong ZHAO ^{1
,

16}
Author Information

1. Department of Infectious Diseases, Center for Liver Disease, Peking University First Hospital, Beijing 100034, China
2. Department of Infectious Diseases, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
3. Department of Infectious Diseases, China-Japan Friendship Hospital, Beijing 100029, China
4. Department of Infectious Diseases, The Third Affiliated Hospital Sun Yat-Sen University, Guangzhou, Guangdong 510000, China
5. Department of Infectious Diseases, South West Hospital Affiliated to Third Military Medical University, Chongqing 400038, China
6. Department of Hepatology, Shanghai Public Health Clinical Center, Fudan University, Shanghai 200083, China
7. Department of Infectious Diseases, Second Affiliated Hospital of Chongqing Medical University, Chongqing 404000, China
8. Department of Infectious Diseases, Xinxiang Medical University Third Hospital, Xinxiang, Henan 453003, China
9. Department of Infectious Diseases, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi 530021, China
10. Department of Infectious Diseases, Di Tan Hospital Affiliated to Capital Medical University, Beijing 100015, China
11. Department of Infectious Diseases, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200090, China
12. Department of Infectious Diseases, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 211166, China
13. Department of Infectious Diseases, Yantai City Hospital for Infectious Disease, Yantai, Shandong 264001, China
14. Shenzhen Key Laboratory of Pathogen and Immunity, State Key Discipline of Infectious Disease, Shenzhen Third People’s Hospital, Shenzhen, Guangdong 518034, China
15. The Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Zhejiang University, Hangzhou, Zhejiang 310085, China
16. Department of Infectious Diseases, Peking University International Hospital, Beijing 102206, China
Collective Name:China Hepatitis B Related Fibrosis Assessment Research Group
Publication Type:Journal Article
Keywords: Chronic Hepatitis B virus infection; Horizontal transmission; Mother-to-child transmission; Progression of disease; Therapeutic efficacy
From: Chinese Medical Journal 2019;132(22):2647-2656
CountryChina
Language:English
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.