Meltem ZENCİR, Alpay ARI, Ali Ilgın OLUT, Sibel ÖZSU CAYMAZ, Selma TOSUN

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HBsAg TAŞIYICISI GEBELERİN VE BEBEKLERİNİN TAKİBİ: OLUŞTURULAN “HASTA TAKİP VE TEDAVİ ALGORİTMASI” KLİNİK SONUÇLARININ DEĞERLENDİRİLMESİ

HBsAg taşıycısı gebelerin izlemi ve bebeğe bulaşın önlenmesi konusunda fikir birliğine varılmış ortak bir rehber bulunmamaktadır. Çalışmamızın amacı HBsAg taşıyıcısı gebelere yönelik pratik bir izlem ve tedavi algoritması geliştirmek ve sonuçlarını klinik olarak değerlendirmektir. Hastanemiz hepatit polikliniğinde 2008-2015 tarihleri arasında izlenen HBsAg pozitif, anti-HCV, delta antikor ve anti-HIV negatif olan 59 kadın hastanın 69 gebeliği ve bunun sonucunda doğan 70 çocuk çalışmamıza dâhil edilmiştir. Bu hastalara gebelik başlangıcında ve 28-32. haftalar arasında HBV DNA ölçümü yapılmış ve son trimesterde HBV DNA düzeyleri yüksek olan (HBV DNA > 106 kopya/ml ve/veya antiviral tedavileri gebelik dolayısı ile kesilmiş hastalara antiviral tedavi başlanmıştır. Bebeklere doğumdan hemen sonra hepatit B immünoglobülin (HBIG) uygulanmış ve hepatit aşılama programına alınmıştır. Aşılama sonrasında ve birinci yılın sonunda bebekler HBsAg ve anti-HBs açısından değerlendirilmiştir. Çalışmaya alınan 69 gebeliğin 56’sı inaktif taşıyıcı, sekizi antiviral tedavi alırken gebe kalmış ve beşi ise tedavi adayı hasta olarak değerlendirilmiştir. Üç gebelikte HBeAg, 66 gebelikte anti-HBe pozitifliği saptanmıştır. Takip başlangıcında tedavi almakta olan gebelerin antiviral tedavileri kesilmiştir. Algoritmamıza uygun olarak 28-32. haftalar arasında HBV DNA ölçümü yapılan gebelerden DNA düzeyi yüksek olan ve/veya antiviral tedavisi gebelik nedeniyle kesilmiş(>106) 13 gebeye antiviral tedavi (10 hastaya lamivudin, ikisine tenofovir, birine telbivudin) başlanmış ve tedavileri gebelik süresince ve sonrası emzirme döneminde de devam etmiştir. Bebeklerin hiçbirinde HBsAg pozitifliği saptanmamış ve tedaviye bağlı yan etki gözlenmemiştir. Bu bulgular ışığında yüksek viremiye sahip HBsAg taşıyıcısı gebelere 3. trimesterde antiviral tedavi uygulanması ve yenidoğan çocuklara yeterli immünoprofilaksi uygulanması ile perinatal bulaşın önlenebileceği ön görülmüştür

The Follow-up of HBsAg Carrier Pregnant Women and Their Infants: Evaluation of the Clinical Results of a “Patient follow-up and Treatment Algorithm”

Currently there is no consensus on a guideline about the follow-up of HBsAg carrier pregnant women and prevention of transmission of infection to the infants. The aim is to form an algorithm for follow-up and treatment of HBsAg carrier pregnant women and evaluate the results. HBsAg positive, anti-HCV, anti-HDV and anti-HIV negative 59 pregnant women and their 69 pregnancies that resulted to 70 live born infants between 2008-2015 were included in the study. HBV DNA was tested at the beginning and between 28-32th week of gestation. From those, antiviral treatment was started at the third trimester to pregnant women with a HBV DNA level of ≥ 106 copy/ml and to those whose antiviral treatments were stopped due to pregnancy. Infants received hepatitis B immunoglobulin (HBIG) and HBV vaccine at birth. At the end of first year all infants were evaluated for HBV infection status. When 69 pregnancies were evaluated, 56 were inactive carriers, eight were on antiviral medication at the beginning of the pregnancy and five were candidates for antiviral treatment. In three pregnancies HBeAg was positive. According to our algorithm antiviral treatment was started at 13 pregnancies and continued during lactation period. HBsAg was negative in all infants at the end of first year and no side effects due to antiviral treatment were observed. Our findings suggested that starting antiviral treatment at third trimester to HBsAg positive pregnant women with high viral load and administration of HBIG and HBV vaccine to infants is effective on prevention of perinatal HBV transmission
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ANKEM Dergisi-Cover
  • ISSN: 1301-3114
  • Yayın Aralığı: Yılda 3 Sayı
  • Başlangıç: 1986
  • Yayıncı: Antibiyotik ve Kemoterapi Derneği
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