Hep B Blog

HBV Journal Review – November 2014

ChrisKHBF 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 Say Breastfeeding While Taking Antivirals Is Safe
  • Doctors Fail to Adequately Treat HBV-Infected Women After Childbirth
  • Doctors Continue to Fail to Screen Asian-Americans for Hepatitis B
  • Statins Protect Hepatitis B Patients Against Heart Disease and Liver Cancer
  • New Study Finds Antivirals Lower Liver Cancer Risk
  • Studies Find Tenofovir Lowers Viral Load Faster Than Entecavir
  • Liver Transplants Safe in Older Hepatitis B Patients
  • Scientists Develop Micro Weapon to Disable HBV’s Cancer-Causing X Protein
  • Foreign-Born U.S. Residents Less Likely to Be Immunized
  • Antivirals Can Safely Replace HBIG Following Liver Transplantation
  • All Hepatitis B Patients Appear at Risk from Chemotherapy

November 1, 2014
Volume 11, Issue 11
by Christine M. Kukka

Experts Say Breastfeeding While Taking Antivirals Is Safe

Women infected with the hepatitis B virus (HBV) face a medical conundrum. If they have high viral loads they are encouraged to take antivirals during pregnancy to reduce their HBV DNA levels to avoid infecting their newborns–but then they’re told not to take antivirals if they want to breastfeed.

A fetus is exposed to far higher levels of an antiviral in utero if the mother takes a daily antiviral pill than through breast milk. And to date, no medical studies have found any harm to babies from exposure to the miniscule amounts of antivirals found in breast milk, according to a provocative study published in the October issue of the journal of Clinical Infectious Diseases.

In fact, the World Health Organization recommends that HIV-infected women continue antiviral treatment (which includes some of the same drugs used to suppress viral load in HBV-infected women) while breastfeeding.

According to the international study spearheaded by Johns Hopkins Bloomberg School of Public Health researchers, breast milk from tenofovir-treated women contains 20% of the levels found in the woman’s blood stream after a 600 mg-pill was taken.

This topic is important because many women need to stay on antivirals after giving birth to prevent “flares” or sudden increases in viral load that can cause liver damage. Also, breastfeeding is far healthier for babies than bottle milk, especially in resource-poor populations.

The researchers suggest antivirals should not be prohibited in nursing mothers, and that current recommendations should be re-evaluated given the lack of proof of any harm posed to babies.

In an editorial accompanying the report, pediatric hepatitis B expert Philip Rosenthal, director of Pediatric Clinical Research at the University of California San Francisco, wrote that the current ban against breastfeeding while on antivirals appears to pit a fetus’ health against that of the mother and newborn.

“The authors (of the study) clearly provide proof that fetal exposure to (antivirals) are much higher than the exposure associated with breastfeeding,” he writes. So what is a doctor to do?

Do you allow the mother to risk a flare of her hepatitis B when you discontinue the drug … so that she can breastfeed her infant? he asked. Do you rely on HIV research that found these drugs can be safely continued while breastfeeding? Do you just ignore the recommendations and allow the mother to breastfeed, or do you prohibit breastfeeding and continue her on antivirals?

He noted that no drug company is going to spend the money or time required to run clinical trials to confirm the safety of antivirals during breastfeeding. So it falls on doctors and advocates to request drug agencies to re-examine the facts, he suggests.

“In the interim, I suspect that each individual physician will need to have a frank conversation with (a) patient prior to delivery,” he writes, to explore the pros and cons of antivirals and breastfeeding so together they can make a decision that benefits both mother and child.

Source: www.ncbi.nlm.nih.gov/pubmed/25313254

Read the HBV Journal Review in its entirety here.

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