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:
- Quality of Care for Women with Hepatitis B Varies Dramatically Across U.S.
- One-third of HBeAg-negative Women Experience “Flares” After Childbirth
- Immunizing Newborns Is an Effective Tool in Preventing Cancer
- Experts Warn: Don’t Delay Treatment in Patients with HBV Genotype C
- Antivirals Help Patients with Cirrhosis, If Started Early Enough
- Entecavir Effective at Clearing HBV’s cccDNA from Liver Cells
- Older Age and a Weakened Immune System Can Cause HBV to Reactivate
- Survey Shows Doctors Fail to Adequately Screen for Liver Cancer
- Innovative Venues Increase Hepatitis B Screening Among Asian-Americans
- Study Finds Waste Collectors at High Risk of Hepatitis B
- Study Comparing Four Antivirals Finds All Appear Effective
February 1, 2015
Volume 12, No 2
by Christine M. Kukka
Quality of Care for Women with Hepatitis B Varies Dramatically Across U.S.
A U.S. Centers for Disease Control and Prevention study, published in the journal Infectious Diseases in Obstetrics and Gynecology, found a large discrepancy in medical treatment for women with hepatitis B-related liver disease.
While scientific evidence shows antivirals are safe in pregnant women and effectively lower the risk of mother-to-child infection, American doctors prescribed antivirals to only 12.6% of pregnant women infected with the hepatitis B virus (HBV). In contrast, they prescribed antivirals to 20% of non-pregnant women.
The important study examined prescription records of 17 million, privately-insured women in 2011. Researchers identified 6,274 women in the study group who were HBV-infected and examined what drugs were prescribed to treat their liver disease.
Pregnant women were most commonly prescribed the antivirals tenofovir (Viread) (73.4%) and lamivudine (Epivir-HBV) (21.9%). The high rate of lamivudine usage is surprising–lamivudine has a high rate of drug resistance and is no longer recommended as a first-line treatment for any patient.
Currently tenofovir and entecavir (Baraclude) are the top two recommended antivirals because of their safety, potency, and low rates of drug resistance.
Among 48 treated pregnant women:
- 16 (33.3%) were prescribed an antiviral before pregnancy and continued treatment for at least one month after delivery. Many women with HBV experience liver-damaging “flares” after childbirth and monitoring and treatment is important during the post-partum period.
- 14 (29.2%) started treatment during the third trimester of their pregnancy–probably to lower viral load to avoid infecting their newborn–and continued antiviral treatment for at least one month after delivery.
Nonpregnant women were most commonly prescribed tenofovir (50.2%) and entecavir (41.3%), as is recommended by current medical guidelines. Surprisingly, these female patients with liver disease had a better chance of getting treatment if they lived in the South, compared to patients living in the Northeast region of the U.S.
“Among this insured population, pregnant women with chronic hepatitis B received an antiviral significantly less often than nonpregnant women,” researchers wrote. The results show the need to examine doctors’ treatment of female patients nationwide, the CDC officials concluded, and to increase antiviral use in pregnant women to prevent infection of newborns.
One-third of HBeAg-negative Women Experience “Flares” After Childbirth
Nearly one-third of HBV-infected women experience liver-damaging “flares” within six months of giving birth, according to a study published in the January 2015 issue of the World Journal of Gastroenterology.