Mehmet Ali NARİN, Suat DEDE, Raziye NARİN³

GEBELİKTE KRONİK HEPATİT B YÖNETİMİ

Gebelikte kronik hepatit B (KHB) enfeksiyonu global bir problem olarak karşımıza çıkmaktadır. Dünyadaki yaklaşık 350 milyon KHB taşıyıcının %50' si enfeksiyonu perinatal dönemde edinmektedir. KHB ile enfekte gebe kadınlar genel nüfustan farklıdır ve hepatit B virüs (HBV) enfeksiyonunun anne ve çocuğa etkisi, gebeliğin HBV replikasyonuna etkileri, gebelik sürecinde annenin antiviral tedavi alıp almayacağı, tedavinin anne ve çocuğa etkileri, yenidoğanın nasıl immünize edileceği ve bunun hastalığa etkileri gibi pek çok özel poblem söz konusudur. HB e Ag pozitif annelerden doğan ve immünprofilaksi yapılmayan infantlarda vertikal geçiş oranı %40-90 düzeyindedir. KHB enfeksiyonlu, doğurganlık çağındaki kadınlar bulaş için önemli bir kaynak durumundadırlar; bu nedenle gebelikte KHB yönetimi perinatal geçişi azaltmak açısından önemli bir süreçtir. Bu derleme perinatal geçişin önlenmesi ve gebelikte tedavisini de içeren KHB yönetimi ile ilgili optimal yaklaşımı özetlemektedir

Management of Chronic Hepatitis B in Pregnancy

Chronic hepatitis B (CHB) virus infection in pregnancy is an important global health problem. Over 50% of the 350 million chronic hepatitis B carriers acquire their infection perinatally. Pregnant women infected with CHB are different from the general population, and their special problems need to be considered: such as the effect of hepatitis B virus (HBV) infection on the mother and fetus, the effect of pregnancy on replication of the HBV, whether mothers should take HBV antiviral therapy during pregnancy, the effect of these treatments on the mother and fetus, how to carry out immunization of neonates, whether it can induce hepatitis activity after delivery and other serious issues. Without immunoprophylaxis, infants born to HBeAgpositive mothers have a 40–90% risk of vertical transmission. Women of childbearing age with chronic HBV infection remain an important source of HBV transmission. Thus, the management of chronic HBV infection during pregnancy is an important opportunity to interrupt the perinatal transmission of HBV. This review will provide an optimal approach to a number of issues of HBV management in pregnancy, including the prevention of perinatal transmission and the treatment of chronic hepatitis B in pregnancy

PDF

___

1. Lavanchy D. Worldwide epidemiology of HBV infection, disease burden, and vaccine prevention.J Clin Virol. 2005;34(Suppl. 1): 1–3.
2. Jonas MM. Hepatitis B and pregnancy: an underestimated issue.Liver Int. 2009;29(Suppl. 1): 133–9.
3. Stevens CE, Beasley RP, Tsui J, Lee WC. Vertical transmission of hepatitis B antigen in Taiwan. N Engl J Med. 1975; 292(8): 771–4.
4. McMahon BJ, Alward WL, Hall DB, Heyward WL, Bender TR, Francis DP,et al.Acute hepatitis B virus infection: relation to the clinical expression of disease and subsequent development of the carrier state. J Infect Dis. 1985;151(6): 599–603.
5. World Health Organization. Hepatitis B. World Health Organization fact sheet 204. Available at:http://who.int/inffs/en/fact204.html.
15. Luppi P, Haluszczak C, Trucco M, Deloia JA. Normal pregnancy is associated with peripheral leukocyte activation.Am J Reprod Immunol. 2002;47(1):72–81.
16. Ornoy A, Tenebaum A. Pregnancy outcome following infections by coxsackie,echo, measles, mumps, hepatitis, polio, and encephalitis virus. Reprod Toxicol. 2006;21(3):446–57.
17. Keeffe EB, Dieterich DT, Han SB, Han SH, Jacobson IM, Martin P, et al. A treatment algorithm for the managementof chronic hepatitis B virus infection in the United States: 2008 update. Clin Gastroenterol Hepatol. 2008;6(12):1315–41.
18. Xu D, Yan Y, Choi BC, Xu JQ, Men K, Zhang JX, et al. Risk factors and mechanism of transplacental transmission of hepatitis B virus: a case-control study. J Med Virol. 2002;67(1):20–6.
19. Pande C, Kumar A, Patra S, Trivedi SS, Dutta AK, Sarin SK. High maternal hepatitis virus DNA levels but not HBeAg positivity predicts perinatal transmission of hepatitis B to the newborn. Gastroenterology. 2008;134(1):760.
20. Tang JR, Hsu HY, Lin HH, Ni YH, Chang MH. Hepatitis B surface antigenemia at birth: a longterm follow-up study. J Pediatr. 1998;133(3):374–7.
21. European Association For The Study Of The Liver. EASL Clinical Practice Guidelines: management of chronic hepatitis B. J Hepatol. 2009; 50(2): 227-242.
22. Chotiyaputta W, Lok AS. Role of antiviral therapy in the prevention of perinatal transmission of hepatitis B virus infection [editorial]. J Viral Hepat. 2009;16(1):91–3.
23. Tran T. Management of hepatitis B in pregnancy: weighing the options. Cleve Clin J Med. 2009;76(Suppl 3):25–29.
24. Fwu C-W, Chien Y-C, Kirk GD, Nelson KE, You SL, Kuo HS, et al. Hepatitis B virus infection and hepatocellular carcinoma among parous Taiwanese women: nationwide cohort study. J Natl Cancer Inst. 2009;101(11):1019–72.
25. Mast EE, Margolis HS, Fiore, Brink EW, Goldstein ST, Wang SA, et al. A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP) part1: immunization of infants, children, and adolescents. MMWR Recomm Rep. 2005;54(1):1–31.