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Hepatitis B Diagnosis & Monitoring

New USPSTF Recommendation on Hepatitis B Screening for People at High-Risk

Unknown-1Truly historic news! Those living with chronic hepatitis B will be identified sooner and learn more about their HBV infection. They can live full lives by improving their health through regular monitoring, treatment when necessary, and adopting healthy lifestyles that benefit the liver. Symptoms may not occur for decades so many are completely unaware of their infection. If you believe you are at risk, please talk to your doctor about being screened for hepatitis B.

By Ronald Valdiserri, M.D., M.P.H., Deputy Assistant Secretary for Health, Infectious Diseases, and Director, Office of HIV/AIDS and Infectious Disease Policy, U.S. Department of Health and Human Services

On Monday, May 26th, the U.S. Preventive Services Task Force (Task Force) published its final recommendation statement on screening for hepatitis B virus (HBV) infection in individuals at high risk. This recommendation includes adults and adolescents who are not pregnant and who have not been vaccinated, as well as other individuals at high risk for infection.

Click here to better Understand the details of the Task Force Recommendations.

After reviewing the evidence, the Task Force recommends screening people who have the following risk factors for HBV infection:

  • People born in countries and regions with a high prevalence of HBV infection, such as Africa, Southeast Asia, Pacific Islands, China, Middle East, Eastern Europe, and the northern countries in South America;
  • U.S.-born persons not vaccinated as infants whose parents were born in countries or regions with a high prevalence of HBV infection;
  • HIV-positive people, injection drug users, men who have sex with men, and those living with or having sex with someone with HBV infection; or
  • Patients with weakened immune systems or undergoing treatment for kidney failure (hemodialysis).

There are still as many as 2.2 million people in the United States chronically infected with hepatitis B and 15 to 25 percent of those individuals die from liver disease including liver cancer. “Screening can identify people who have chronic HBV infection, and the good news is that treatment can help prevent liver cancer in these people,” says Task Force member Dr. Douglas K. Owens of Stanford University.

The Task Force’s final recommendation statement has been published online in Annals of Internal Medicine , as well as on the Task Force Web site . A fact sheet  [PDF 151KB] explains the recommendation statement in plain language.

“The Task Force’s new Grade B recommendation in favor of HBV screening for persons at high risk for infection – people who are more likely to get infected or to pass on the infection – provides us with another important tool to use as we pursue the goals of the Action Plan for the Prevention, Care and Treatment of Viral Hepatitis,” observed Ms. Corinna Dan, Viral Hepatitis Policy Advisor at the HHS Office of HIV/AIDS and Infectious Disease Policy. “In the weeks and months ahead, federal and nonfederal stakeholders alike will incorporate this recommendation into efforts detailed in the Action Plan to improve viral hepatitis testing, care and treatment to prevent liver disease and cancer.”

See more at:

Hepatitis B Diagnosis & Monitoring, Hepatitis B Prevention, Hepatitis B Treatment, Liver Cancer, Living with Hepatitis B

The World’s Second Deadliest Cancer Is …Preventable

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bandages

Liver cancer is the world’s second leading cause of cancer deaths, according to the latest World Cancer Report 2014 released by the International Agency for Research on Cancer (IARC), which is the specialized cancer agency of the World Health Organization (WHO). About 800,000 deaths per year are related to liver cancer. Continue reading "The World’s Second Deadliest Cancer Is …Preventable" →

Hepatitis B Diagnosis & Monitoring, Liver Cancer

Coffee Consumption Reduces Risk of Liver Cancer

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“Our research confirms past claims that coffee is good for your health, and particularly the liver,” said Carlo La Vecchia, MD. (Credit: © volff / Fotolia)

Coffee consumption reduces risk of hepatocellular carcinoma (HCC), the most common type of liver cancer, by about 40 percent, according to an up-to-date meta-analysis published in Clinical Gastroenterology and Hepatology, the official clinical practice journal of the American Gastroenterological Association. Further, some data indicate that three cups of coffee per day reduce liver cancer risk by more than 50 percent.

Read more. 

Posted in Science Daily, October 22, 2013

Hepatitis B Diagnosis & Monitoring, Hepatitis B Prevention, Hepatitis B Treatment, Living with Hepatitis B

HBV Journal Review – October 2013

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HBF is pleased to connect our blog readers to Christine Kukka’s monthly HBV Journal Review that she writes for the HBV Advocate. The journal presents the
latest in hepatitis B research, treatment, and prevention from recent academic and medical journals. This month, the following topics are explored:

  • Study Finds Only 21% of Hepatitis B Patients Are Treated Correctly
  • Combination of Chinese Herbs Plus Antiviral Entecavir Proves Effective
  • Caesarians Reduce Infection of Newborns When Mothers Have High Viral Loads
  • Combined Antiviral and Interferon Treatment Effective in Those Under Age 30
  • New Tenofovir Formula May Lead to Less Bone Loss and Kidney Problems
  • HBV Mutation Found Only in Men May Explain Their Higher Rates of Liver Damage
  • Sumo Wrestlers Found to Transmit HBV Infection
  • Taiwan’s Hepatitis B Immunization of Infants Reduces Hepatitis B by 90%
  • Tenofovir Reverses Severe, Decompensated Cirrhosis

HBV Journal Review
October 1, 2013
Volume 10, Issue 10
by Christine M. Kukka 

Study Finds Only 21% of Hepatitis B Patients Are Treated Correctly

A new study, examining how well San Francisco primary care providers care for their patients infected with the hepatitis B virus (HBV), finds most fail to screen them for liver cancer or regularly evaluate their viral load or hepatitis B “e” antigen (HBeAg) status, though medical guidelines require annual or semi-annual testing.

The study, published in the September 2013 issue of the journal Digestive Diseases and Sciences, surveyed doctors who provide care through a safety net program to many uninsured patients. They were asked how well they thought they followed current medical guidelines, and then patient medical records were analyzed to assess the true quality of care.

Of the 148 doctors surveyed, 79% claimed to follow medical guidelines and monitor patients’ liver health every 6 six 12 months. However, patient medical records covering the last 12 months showed substandard care.

  • • Only 75% of patients had their alanine aminotransferase (ALT) levels, which shows liver damage, tested in the past year.
  • • Only 51% had their viral load (HBV DNA) tested.
  • • Only 51% had been screened for liver cancer (either with an alpha fetoprotein test or some type of liver imaging). This test should be performed annually, and doctors are at risk of medical malpractice if they do not screen patients for cancer.
  • • HBeAg tests were performed in only 29% of patients.
  • • Only 32% of the hepatitis B patients had been immunized against hepatitis A, another guideline requirement, to protect them from another liver infection.

Bottom line, researchers found that only 21% of patients had been monitored properly in compliance with current hepatitis B guidelines. Forty-three percent of doctors were not familiar with medical guidelines for hepatitis B management and only 73% answered all questions about hepatitis B correctly.

There was also a racial bias regarding which HBV-infected patients were screened for hepatitis C and HIV. Doctors tended to test African-American and Latino patients for hepatitis C (48% and 44% respectively) at a higher rate than they tested whites and Asian-American patients (34% and 31%.)

The study suggests that fear of malpractice—more than knowledge of current practice guidelines—may drive doctors to perform the required liver cancer screenings each year. Also, the researchers suggest that hepatitis B public education initiatives, spearheaded by the San Francisco Hepatitis B Free Campaign, may have contributed to better monitoring of Asian-Americans because it raised awareness among the public and their providers.

“These findings highlight the importance of targeted provider education to improve overall care,” for hepatitis B, the researchers from the University of California, San Francisco, suggest.

Continue reading about this and additional HBV related studies

Hepatitis B Diagnosis & Monitoring, Living with Hepatitis B

Protein Myths and Your Liver

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Liver-friendly diets are a common concern for those with chronic hepatitis B wishing to make healthy lifestyle choices. Protein is essential to all, but there are healthier ways to consume necessary proteins.  Please enjoy this informative blog from the Al D. Rodriguez Liver Foundation – ADRLF, on Protein Myths and Your Liver written by ToniMarie Bacala.

We all love need protein – whether it be from animals or plants—protein gives us essential amino acids we need to keep our bodies strong and healthy. But how much do we really understand about protein and its effects on our organs, especially the liver? Is there such as thing as too much protein, even if its from vegetables and grains? Let’s delve into two popular protein myths and how we can ensure our protein intake is safe for our liver.

Love meat? Learn more about healthy proteins to protect you liver.
Love meat? Learn more about healthy non-animal meat proteins to protect you liver and keep your body healthy.

Protein is made of 20 different amino acids, but only 11 of which can be naturally synthesized by our body. The other types of protein come from the food we eat. Essentially, it’s safe to say that while protein helps in building the cell wall, strengthening muscle tissues and supporting cell functions, our body actually just needs certain types of amino acids.

So myth or truth? The best source of protein is animal meat. MYTH

Eating red meat requires our digestive system, as well as our liver to do a lot of work processing the heavy bulk of protein. Experts suggest limiting the amount of red meat we eat to at most one serving a day.

There are other good sources of proteins like whole grains, green vegetables, nuts, peas and beans. Fruits also contain small amounts of protein. Compared to animal meat, vegetables and beans have phytochemicals, antioxidants and other nutrients. Nuts and beans containing antioxidants help the liver process the food and beverage that we take in, making it a healthier source of protein.

Myth or truth? People desiring to build lean muscle mass can eat as much protein-rich food as they want.

MYTH.

There is such a thing as too much protein. While protein is an essential nutrient, the overall health of our body lies in having a balanced diet. People building up muscles such as athletes and bodybuilders are no different.

The advisable amount of protein intake for men also differs from women. Consult your doctor or a nutritionist who can give you the appropriate amount of protein you should include in your diet, as based on your weight, age and daily activities. There are also vegan bodybuilders who get much of their protein requirements from vegetables and grains.

Eating too much protein can cause several health conditions such as ketosis, organ failure, and heart diseases. Too much protein can also be dangerous and stressful to the liver. So look out for other protein myths with the basic truth in mind: Keep protein intake in moderation and explore the benefits of non-animal sources of healthy proteins.

Hepatitis B Diagnosis & Monitoring, Hepatitis B Prevention, Hepatitis B Treatment

HBV Journal Review – September 2013

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HBF is pleased to connect our blog readers to Christine Kukka’s monthly HBV Journal Review that she writes for the HBV Advocate. The journal presents the
latest in hepatitis B research, treatment, and prevention from recent academic and medical journals. This month, the following topics are explored:

  • 39.2% of U.S. Newborns Aren’t Getting Hepatitis B Vaccine at Birth
  • Researchers Suggest Banning or Restricting Lamivudine to Avoid Drug Resistance
  • Knowledge Gap About Hepatitis B Persists Among Asian-Americans
  • Even Liver Specialists Fail to Immunize Patients Against Viral Hepatitis
  • Many Seek Viral Hepatitis Tests Only When Symptoms Appear
  • After Six Years of Tenofovir Treatment, Still No Signs of Drug Resistance
  • More Studies Examine Link Between Vitamin D and Liver Damage
  • Study Examines Which Hepatitis B Patients Relapse with Chemotherapy
  • Interferon Treatment May Cause Some Hearing Loss
  • African-Americans Suffer the Highest Rates of New HBV Infections in the U.S.

HBV Journal Review
September 1, 2013
Volume 10, Issue 8
by Christine M. Kukka 

 

 39.2% of U.S. Newborns Aren’t Getting Hepatitis B Vaccine at Birth

Which newborns aren’t getting immunized against hepatitis B in the U.S.? The infants who:

  • • Do not have health insurance
  • • Live in states without a universal hepatitis B vaccine supply policy
  • • And have only one provider who administered vaccines.

According to a U.S. Centers for Disease Control and Prevention study, published in the August issue of the journal Preventive Medicine, an alarming 39.2% of newborns missed the first, critical birth dose of hepatitis B vaccination that can protect newborns from hepatitis B even if their mothers are infected.

These results come from data analysis of the 2009 National Immunization Survey of 17,053 U.S. children, aged 19-35 months.

“Children who reside in states without a universal hepatitis B vaccine supply policy, and are not covered by health insurance are two important modifiable risk factors for not receiving the birth dose hepatitis B vaccination, future intervention studies could be needed to help control those modifiable risk factors,” CDC researchers wrote.

Source: www.ncbi.nlm.nih.gov/pubmed/23988497

Researchers Suggest Banning or Restricting Lamivudine to Avoid Drug Resistance
A global team of researchers suggest lamivudine (Epivir-HBV) never be used to treat hepatitis B patients because it frequently leads to drug resistance and sets the stage for resistance to other antivirals, such as entecavir (Baraclude).

Lamivudine, the first antiviral approved for hepatitis B treatment, has fallen out of favor in North America and Europe because of its high rate of drug resistance. But because of its low cost, it continues to be commonly used to treat hepatitis B virus (HBV) infection in Asia and Africa, where the majority of the world’s hepatitis B patients live.

This report, published in the July 30 issue of PLoS One, examined the molecular make-up of the virus in many patients who had been treated with lamivudine as well as patients who had never been treated. They found the many untreated patients carry a mutation that allows HBV to quickly mutate and develop resistance to lamivudine.

“Our findings strongly suggest that the use of lamivudine will not benefit …patients,” they wrote because of the high risk of lamivudine resistance.

“Finally, since patients can quickly develop drug resistance to entecavir in the presence of lamivudine mutations, the lamivudine mutations can significantly compromise the efficacy of entecavir,” they concluded.

They proposed that doctor screen patients for these mutations before ever prescribing lamivudine,”… to most effectively treat chronic hepatitis B patients by selecting only sensitive drugs.” …

Continue reading about this and additional HBV related studies

Hepatitis B Diagnosis & Monitoring, Hepatitis B Treatment, Living with Hepatitis B

Diagnosed With Chronic Hepatitis B? What Phase – HBeAg-Positive Chronic Hepatitis / Immune Reactive / Immune Clearance?

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In the last chronic hepatitis B stages blog, we looked at the HBeAg-Positive Chronic Infection (formerly known as immune tolerant).

At some point the immune system recognizes the hepatitis B virus and the chronically infected person will enter a phase referred to as the  HBeAg–positive chronic hepatitis- (previously known as immune reactive/immune clearance). During this phase blood work will show that you are HBeAg positive, with lower levels of HBV DNA when compared to the HBeAg-positive chronic infection/immune tolerant stage, and increased ALT (SGPT) levels. (Remember, it is not at all unusual for kids to have viral loads in the millions or even billions.) During this “clearance” phase the immune system is actively attacking infected liver cells. This is both good and bad. On the good side, if the immune system is able to “beat” the virus, the person will go through HBeAg seroconversion and lose the HBeAg antigen. This means that HBeAg will go from positive to negative and the HBeAb antibody, or anti-HBe will go from negative to positive.  This results in significant decrease in the hepatitis B virus level, often to an undetectable level, and normalization of ALT/AST liver enzymes and other liver function blood test results. Successful HBe serconversion moves you into the HBeAg-negative chronic infection/inactive carrier phase.

When the immune system activates and starts attacking infected liver cells, it not only kills the virus, but also the host liver-cells. You may not feel any of this, but your ALT (SGPT) and AST (SGOT) lab values will be elevated. These enzymes are released when there is inflammation caused by liver cells that are injured or killed.  Your doctor may see a mild, moderate or high levels of ALT elevation reflecting inflammation in the liver. Ultimately the problem is how much inflammation and liver damage occurs during the process of HBeAg seroconversion?

It is possible a person will quickly and spontaneously move into and out of the HBeAg-positive chronic hepatitis/immune reactive phase, and with a limited amount of inflammation and liver damage. However, some people may cycle up and down for years with intermittent flares, which are evidenced by ALT elevations which may be as high as 10 times above the upper limits of normal (normal is 35 IU/mL for men and 25 IU/mL for women) when in the immune reactive phase.  While the immune system attacks infected liver cells, viral replication will decrease and ALT levels will elevate as infected liver cells die in the battle.  If successful, the immune system response will result in HBe seroconversion –  losing HBeAg, gaining the HBe antibody, and a decline of the viral load  (HBV DNA) to very low or undetectable levels, and the normalization of ALT/AST and other liver enzyme levels.

Unfortunately, that might not be enough, and the immune system may not be able to put up a big enough fight permitting HBe seroconversion to a less active or HBeAg negative chronic infection /inactive carrier phase. Evidence of this is ALT levels that go back down, and viral replication that goes back up. (Note the above diagram.) This cycling up and down over time will be reflected in lab work if a liver specialist monitors you regularly over time. If you are not having your ALT levels regularly monitored (every few months), then you may miss these cycles of intermittent elevations or flares over time. It is during these elevations that liver damage occurs, and you will likely be completely unaware, unless you have lab work done while liver enzymes are elevated, or you wait until there are symptoms and significant liver damage.

It is during the immune clearance phase when treatment is sometimes recommended. It is true that a chronically infected person will eventually serconvert HBe spontaneously – without treatment, but most liver specialists choose to treat in order to prevent years of ALT elevations and flares and subsequent damage to the liver.

If you appear to be in the HBeAg-Positive Chronic Hepatitis / Immune Reactive phase, be sure you continue with regular monitoring with your doctor and don’t be afraid to ask questions about your hep B infection and the health of your liver.

 

Hepatitis B Diagnosis & Monitoring, Hepatitis B Prevention, Living with Hepatitis B

Kudos to HBF’s Blog Voted as a “Sexual Health Top 10, Must Read Blog”

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The team at Health Express has voted HBF’s blog as one of the “Must Read Blogs of 2013 – Sexual Health Top 10!”  HealthExpress.co.uk is an online clinic that provides support, advice and treatment for common medical conditions that patients do not always feel comfortable talking about. You can take a look at their recommended Top 10 blogs and learn more about them at healthexpress.co.uk.

The accolades from the HealthExpress team are a great opportunity to review transmission of the hepatitis B virus. HBV is transmitted through infected blood and body fluids. This includes direct blood-to-blood contact, unprotected sex, unsterile needles, and from an infected woman to her newborn baby at birth.  Sharing sharp, personal items that may have trace amounts of blood on them such a razors, toothbrushes, nail clippers and body jewelry including earrings, can also spread the virus.  Remember that the HBV virus may live up to a week on a surface resulting in possible transmission through direct blood-to-blood contact. This is why close, household contacts or family members are at greater risk of infection if one or more members are living with HBV. Don’t forget to be sure your tattoo or piercing experience is safe and that the parlor carefully follows infection control practices. Hepatitis B is also 50-100 times more infectious than the HIV virus.

Hepatitis B is also a sexually transmitted disease and is spread through infected semen, vaginal fluids and any blood that may be exchanged as part of a sexual practice – most often through sexual intercourse. In the United States, sexual transmission is the most common mode of HBV transmission and is responsible for 2/3 of acute HBV infections. A common question is “what about oral sex?” In general, oral sex would be considered less risky, but any kind of intimate sharing that may result in the exchange of bodily fluids will present some degree of risk.

So how can you prevent hepatitis B transmission between sexual partners? Fortunately there is a safe and effective hepatitis B vaccine to protect against the spread of HBV.  Get screened for HBV and vaccinate to protect – especially if you or your partner has more than one sexual partner, or if one or more partners is at greater risk.  When in doubt, get screened. Keep in mind that HBV is referred to as a “silent infection” since it may take decades for symptoms to occur. People with chronic HBV may be completely unaware of their infection and inadvertently spread HBV to their partner(s) if precautions are not taken.

Other precautions include practicing safe sex by using a latex or polyurethane condom. A lambskin condom will not prevent the spread of hepatitis B or other viral STDs. Looking for condom details?

A general comment to those with multiple sex partners– We are very fortunate to have a vaccine to protect against the hepatitis B virus. However, practicing safe sex with an effective condom is always advised to prevent the transmission of other infectious diseases that are not vaccine preventable, such as HCV and HIV, along with condom use to prevent the spread of other sexually transmitted diseases. Use common sense. No one wants a sexually transmitted disease, and if you have HBV, you really don’t want a coinfection. It can really complicate your life.

Hepatitis B Diagnosis & Monitoring, Hepatitis B Prevention

World Hepatitis Day in Ghana

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Ghanians lined up for a viral hepatitis screening at last year's World Hepatitis Day event in Tamale, Ghana (Northern Region)

HBF is pleased to share World Hepatitis Day plans of our friend Theobald Owusu-Ansah of the Theobald Hepatitis B Foundation in Ghana. The Foundation is also a voting member of the World Hepatitis Alliance. 

On July 28th, 2013, The Theobald Hepatitis B Foundation and the Hepatitis Coalition of Ghana will join the World with one voice to celebrate World Hepatitis Day in Sunyani at Victoria Park. In attendance will be the Chiefs, members of Parliament, District Chief Executives, Municipal Chief Executives, Assembly Members and all the Opinion Leaders of the Region.

The Theobald Hepatitis B Foundation is a non-profit organization whose main aim is to educate and create awareness of hepatitis B and C to the general public, ranging from the causes, and symptoms of viral hepatitis, to preventive measures.

On World Hepatitis Day, the activities will start with an early morning Float with music and dance throughout the principal streets of Sunyani, along with the members and volunteers of the Foundation and the Coalition distributing educational materials to the crowds. These leaflets, posters, banners and stickers are part of the ongoing media blast that will draw the public’s attention to problem of chronic hepatitis B among the people of Ghana.

Free screening and hepatitis B vaccinations will be ongoing throughout the day’s activities. Resource persons will be delivering their messages and educating the general public about viral hepatitis. It is important that the people learn and understand whether or not they are positive or negative for viral hepatitis, and if they are positive, what is next.

The Delegation of the Government and other health care professionals will educate the public on Viral Hepatitis Policies and the way forward. Dieticians will also take the general public through the kind of food and diet one needs to eat, and the importance of avoiding alcohol, in order to defuse the public cry of the cost of prevention and treatment of hepatitis B.

Participating organizations will then take the opportunity to appeal for funds from the government officials and the Chiefs of the region present, in order to enable us to successfully organize our last programme of the year.

At the end of the event, the public will be provided with advice, and directed to seek medical information from qualified health professionals, in order to avoid falling into wrong hands of those trying to sell false cures for those with hepatitis B.

Please join us for our World Hepatitis Day activities in Victoria Park if you are in Sunyani, Ghana.

Theobald Owusu Ansah
Theobald Hepatitis B Foundation
P.O. Box GP 21325 Accra-Ghana:

Phone: 00233-20-8269214
theobald2003@yahoo.com
Theobald Hepatitis B Foundation website

 

Hepatitis B Diagnosis & Monitoring, Hepatitis B Treatment

HBV Journal Review – July 2013

HBF is pleased to connect our blog readers to Christine Kukka’s monthly HBV Journal Review that she writes for the HBV Advocate. The journal presents the
latest in hepatitis B research, treatment, and prevention from recent academic and medical journals. This month, the following topics are explored:

*Experts Describe When to Treat Pregnant Women with Antivirals
Does pregnancy worsen hepatitis B?
When should pregnant women be treated?
Which antivirals are safe to use during pregnancy?
What if women have elevated ALTs before becoming pregnant and have never         been treated?
What about women with normal ALTs and high viral loads?
Is it safe to use antivirals during the entire pregnancy?
Monitoring recommendations after delivery
Can a woman taking antivirals breastfeed?
* Half of Patients Treated Long-Term with Tenofovir Lose HBeAg
*Even Patients with High Viral Load Lose HBeAg with Tenofovir
*New Type of Interferon Effective in Phase 2 Hepatitis B Trial
*Majority of Hepatitis B Patients Have Vitamin D Deficiency
*But Patients with Healthy Vitamin D Levels Are More Likely to Clear HBsAg
*Activists Develop a National Plan to Eradicate Hepatitis B in the U.S.
*New Guidelines Urge Britain’s Doctors to Improve Hepatitis B Care
*Measuring HBsAg Levels May Identify Fibrosis and Avoid Liver Biopsies
*HBsAg Levels May Also Predict Cancer Risk in HBeAg-negative Patients

HBV Journal Review


July 1, 2013, Vol 10, no 7
by Christine M. Kukka

Experts Describe When to Treat Pregnant Women with Antivirals
Two U.S. hepatitis B experts have crafted guidelines for doctors to use when deciding when to treat pregnant women infected with the hepatitis B virus (HBV) with antivirals in order to safeguard the women’s health and prevent infection of newborns.

More than half of new hepatitis B infections result from mother-to-child (vertical) transmission and despite immediate immunization and administration of HBIG (hepatitis antibodies), about 30% of infants born to women with high viral loads become infected. Additionally, women who want to become pregnant may already be treated with antivirals because of liver damage.  There is little medical guidance on whether treatment is safe over the entire pregnancy.

Does pregnancy worsen hepatitis B? Generally it does not unless the woman has cirrhosis (severe liver scarring.) Studies show a pregnant woman’s viral load generally does not increase over a pregnancy, but after the baby is born and the woman’s hormone levels change (akin to a sudden decline in steroids), some women experience a “flare” and their alanine transaminase (ALT) levels may increase due to moderate liver cell damage. Because of these flares, doctors must monitor new mothers carefully for several weeks after childbirth.

When should pregnant women be treated? Starting in the second or third trimester of pregnancy, antiviral treatment is recommended when women have high viral loads—exceeding 1 million copies per milliliter or 200,000 international units per milliliter. However, if women are already receiving antiviral treatment when they become pregnant, treatment should probably continue over the pregnancy to prevent worsening liver disease.

Which antivirals are safe to use during pregnancy? The experts recommend tenofovir (Viread) in the event the woman continues to need antiviral treatment because this drug has a very low rate of drug resistance, or telbivudine (Tyzeka). Both have been shown to be safe and cause no birth defects when used in pregnant women infected with HIV or HBV.

Continue reading about this and additional studies…


Baruch S. Blumberg Institute