Am J Obstet Gynecol. 2022 Mar 6:S0002-9378(22)00170-3. doi: 10.1016/j.ajog.2022.02.042. Online ahead of print.
ABSTRACT
OBJECTIVES: This study investigated the efficacy and safety of pharmacological interventions to prevent vertical transmission of hepatitis B virus.
DATA SOURCE: Medline, Cochrane and Scopus databases were searched up to 28th October 2020.
STUDY ELIGIBILITY CRITERIA: All randomized controlled trials reporting vertical hepatitis B virus transmission with pharmacological intervention were included.
STUDY APPRAISAL AND SYNTHESIS METHODS: Risk of bias was assessed using the Cochrane Risk-of-Bias tool Version 2. Treatment efficacy was estimated using stratified network meta-analysis based on maternal hepatitis B envelope antigen status.
RESULTS: Nineteen studies were included for mothers positive for hepatitis B surface and envelope antigens. Pooling indicated a combination of hepatitis B vaccine and hepatitis B immunoglobulin in infants significantly reduced transmission risk compared to vaccine alone with a risk ratio of 0.52 (95% confidence interval 0.30, 0.91). Only the addition of maternal tenofovir disoproxil fumarate, but not telbivudine, lamivudine, or maternal hepatitis B immunoglobulin further reduced transmission risk compared to a combination of hepatitis B vaccine and hepatitis B immunoglobulin in infants, with a pooled risk ratio of 0.10 (0.03, 0.35). Twelve studies conducted in mothers with hepatitis B surface antigen positivity and mixed, unknown or negative hepatitis B envelope antigen status, provided limited evidence to suggest that maternal hepatitis B immunoglobulin combined with hepatitis B vaccine and immunoglobulin in infants was the likely best treatment, but this failed to reach statistical significance compared to a combination of hepatitis B vaccine and immunoglobulin in infants. Similarly, infant hepatitis B immunoglobulin, added to vaccination, likely provides additional benefit but again failed to reach statistical significance.
CONCLUSION: A combination of hepatitis B vaccine and immunoglobulin in infants is the cornerstone for prevention of vertical transmission for mothers double positive for both hepatitis B surface and envelope antigens. The addition of maternal tenofovir in this infant combination regimen was considered the likely most effective treatment. For infants of mothers with hepatitis B surface antigen positivity and mixed, unknown or negative hepatitis B envelop antigen status, no additional agents provided further benefit beyond hepatitis B vaccine alone.
PMID:35263648 | DOI:10.1016/j.ajog.2022.02.042
