Zhongjie Shi

Lamivudine in late pregnancy to interrupt in utero transmission of hepatitis B virus: a systematic review and meta-analysis.

OBJECTIVES: To evaluate efficacy of lamivudine in reducing in utero transmission of hepatitis B virus (HBV). DATA SOURCES: A database was constructed from Medline, EMBASE, Cochrane Library, National Science Digital Library, China Biological Medicine Database, and through contact with experts in the field from January 1990 to October 2009. METHODS OF STUDY SELECTION: We used the Jadad score and Cochrane Collaborations tool for assessing risk of bias. TABULATION, INTEGRATION, AND RESULTS: We abstracted data regarding HBV intrauterine infection, mother-to-child transmission, maternal HBV DNA level, treatment methods, and adverse effects. All newborns followed joint immune prophylaxis schedule of hepatitis B vaccine and hepatitis B immunoglobulin after delivery. The Mantel-Haenszel random-effects model was employed for all analyses using odds ratio (OR) and 95% confidence interval. Newborns in the lamivudine group had a 13.0–23.7% lower incidence of intrauterine infection, indicated by newborn hepatitis B surface antigen (0.38, 0.15–0.94, six randomized controlled trials [RCTs], P=.04) and HBV DNA (0.22, 0.12–0.40, four RCTs, P<.001) seropositivity, and a 1.4–2.0% lower mother-to-child transmission rate at 9–12 months, indicated by infant hepatitis B surface antigen (0.31, 0.15–0.63, four RCTs, P<.01) and HBV DNA (0.20, 0.10–0.39, two RCTs, P<.001) seropositivity. No significant higher adverse effects or complications in pregnancy were observed. CONCLUSION: Lamivudine in HBV carrier–mothers with high degree of infectiousness in late pregnancy effectively prevented HBV intrauterine infection and mother-to-child transmission.

Breastfeeding of newborns by mothers carrying hepatitis B virus: a meta-analysis and systematic review.

OBJECTIVEnTo perform a systematic review of prospective studies to confirm the role of breastfeeding in mother-to-child transmission (MTCT) of hepatitis B virus (HBV).nnnDATA SOURCESnA database was constructed from MEDLINE, EMBASE, Cochrane Library, National Science Digital Library, and China Biological Medicine Database and through contact with experts in this field from January 1, 1990, to August 31, 2010.nnnSTUDY SELECTIONnAll studies were peer reviewed and met the preset inclusion standards.nnnMAIN EXPOSUREnBreastfeeding.nnnMAIN OUTCOME MEASURESnData regarding HBV intrauterine infection, MTCT, maternal blood and breast milk infectiousness, infant immunoprophylaxis methods and response, and adverse events. The Mantel-Haenszel fixed-effects model was used for all analyses using odds ratios and 95% confidence intervals.nnnRESULTSnTen qualified studies were included. All were clinical controlled trials, involving 751 infants in the breastfeeding group and 873 infants in the nonbreastfeeding group. As indicated by infant peripheral blood hepatitis B surface antigen or HBV DNA positivity at age 6 to 12 months, the odds ratio of MTCT of HBV in the breastfeeding group compared with that in the nonbreastfeeding group was 0.86 (95% confidence interval, 0.51-1.45) (from 8 clinical controlled trials, P = .56; I(2) = 0%, P = .99). As indicated by infant peripheral blood hepatitis B surface antibody positivity at age 6 to 12 months, the odds ratio of development of hepatitis B surface antibodies in the breastfeeding group compared with that in the nonbreastfeeding group was 0.98 (95% confidence interval, 0.69-1.40) (from 8 clinical controlled trials, P = .93; I(2) = 0%, P = .99). No adverse events or complications during breastfeeding were observed.nnnCONCLUSIONnBreastfeeding after proper immunoprophylaxis did not contribute to MTCT transmission of HBV.

Immunopathogenesis of chronic hepatitis B

Chronic hepatitis B (CHB) is a widespread infectious disease with unfavorable outcomes and life-threatening consequences for patients, in spite of modern vaccination and antiviral treatment modalities. Cutting-edge experimental approaches have demonstrated key pathways that involve cross-talk between viral particles and host immune cells. All events, including penetration of hepatitis B virus (HBV) particles into host cells, establishing persistence, and chronization of CHB infection, and possibility of complete elimination of HBV particles are controlled by the immune system. Researchers have paid special attention to the replication capacity of HBV in host cells, which is associated with cellular changes that reflect presentation of viral antigens and variability of HBV antigen features. In addition, specific HBV proteins have an immune-modulating ability to initiate molecular mechanisms that avoid control by the immune system. The relationship between immunological shifts and chronic infection stages has been intensively studied since it was recognized that the immune system is a direct participant in the recurrent (cyclic) nature of CHB. Understanding the wide diversity of molecular pathways and the crosstalk between innate and adaptive immune system components will provide fresh insight into CHB immune pathogenesis and the possibilities of developing new treatment strategies for this disease.

Mother‐to‐child transmission of HBV: review of current clinical management and prevention strategies

Mother‐to‐child transmission (MTCT) of HBV is responsible for approximately half of the HBV transmission routes and continues to be a challenging problem worldwide. Even after the development of effective vaccines and clear World Health Organization guidelines toward HBV several decades ago, 1–9% newborns of HBV‐carrying mothers still acquire HBV in early life as a result of in utero infection. The prevention of MTCT is of high importance, because chronically infected individuals function as a reserve for sustained HBV transmission, and 25% of them can develop asymptomatic liver cirrhosis and hepatocellular carcinoma. In this article, we review the canonical and novel HBV infection routes/mechanisms, influencing factors, diagnostic criteria, and interruption strategies for HBV MTCT. The preventative strategy of HBV MTCT has evolved from routine postpartum HB immune globulin (HBIG) plus HB vaccine schedules to administration of HBIG or nucleoside analogs during pregnancy and minimizing the exposure of maternal body fluids to the newborn during delivery. Copyright

Obstetrical Management of Fulminant Viral Hepatitis in Late Pregnancy

Objective: To set up a routine perinatal treatment guideline for fulminant viral hepatitis in late pregnancy (FVHLP). Method: A summary of literature of successful treatment at various clinical stages. Due to the limited number of prospective studies, retrospective, observational studies and case reports were analyzed and pathophysiological mechanisms were summarized as well. Results: A comprehensive obstetrical treatment guideline was proposed as follows: (a) Awareness of FVHLP should be reinforced among medical staff; (b) Patients diagnosed with FVHLP should be transported to regional expert centers before labor onset; (c) Supportive medication should be administered to prepare the patients for incoming delivery. A central venous line should be maintained to provide rapid intravenous access and monitor central venous pressure before operation start; (d) Caesarean section is recommended for the mode of delivery, followed by peripartum hysterectomy to control postpartum hemorrhage; (e) Peritoneal/abdominal lavage and drainage tube placement are recommended following operation to decrease abdominal pressure and detect post-operational bleeding; (f) Hypertonic glucose along with insulin topical injection is recommended to promote the healing of wound; (g) Supportive medication, replenishment of coagulation factors, preventive antibiotics should be given as needed. Adjust the amount and order of intravenous fluid according to the character and amount of drainage and urine. Conclusion: Vital obstetrical measures taken include supportive treatments, delivery at appropriate time by cesarean section, and prevent and control of various complications. Guidelines developed with more robust research are still needed