A Case Report of a Pregnant Woman with Chronic Hepatit B: Use of Tenofovir in Pregnancy

Abstract

Question: Chronic Hepatitis B infection is a serious public health problem. Hepatit B virus (HBV) may transmit to the fetus vertically in delivery. Antiviral treatment during pregnancy and immunoprophylaxis (Hepatitis B immune globulin and HBV vaccine) in first 12 hours after birth, play an important role in preventing the vertical transmission from mother to baby. The transmission rate is higher if mother's serum HbeAg is positive and HBV-DNA level is high (>200.000 IU/mL or 106 copy/mL). Telbivudine, lamivudine and tenofovir are usually preferred in pregnancy because of the more number of studies related to their safe use in pregnancy. This study aimed to overview the effects of tenofovir use in chronic Hepatit B in pregnancy and asses the effects on the vertical transmission of HBV from mother to baby. Method(s): We presented a pregnant woman who has chronic Hepatit B with high viral load (155.587 IU/mL) at 26 weeks of gestation. Biochemical parameters other than HBVDNA level were measured normally at 26 weeks of gestation. Although two-week antiviral treatment proposal she has not received any antiviral therapy until her admission to Dokuz Eylul University Medical Pharmacology Teratogenity Unit. HBV-DNA level was determined as 1.990.000 IU/mL at 37 weeks of gestation. She took 245 mg of tenofovir once a day along six days at 37 weeks of gestation. Result(s): The patient gave birth to a healthy baby who had normal APGAR score without any malformation. Immunoprophylaxis were administered to the infant within 12 hours after delivery. Baby's Hepatitis B markers and liver function tests were found within normal limits at weeks 14 and 25. Mother's HBV-DNA level was determined as 5670 IU/mL and liver function tests were within normal limits at postpartum week 14. Conclusion(s): When viral load is high in pregnant women with chronic HBV carrier; pregnants should be treated with Tenofovir at 28-30 weeks of gestation, however the time of discontinuation of the treatment is not clear. In general, it is stated that antiviral treatment may discontinued within the first 4 weeks postpartum but in practice the treatment could be continued until the postpartum 6th month. This case report showing that only six day tenofovir use may contribute to preventing vertical transmission of HBV from mother to baby. However, the importance of HBIG and vaccination should not be forgotten.