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Thématique :
- Foie
Originalité :
Intermédiaire
Solidité :
Très solide
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Professeur Christine SILVAIN
Coup de coeur :
 
 
Hepatology
  2016/11  
 
  2016 Nov;64(5):1451-1461  
  doi: 10.1002/hep.28589  
 
  Quantitative maternal hepatitis B surface antigen predicts maternally transmitted hepatitis B virus infection.  
 
  Wen WH, Huang CW, Chie WC, Yeung CY, Zhao LL, Lin WT, Wu JF, Ni YH, Hsu HY, Chang MH, Lin LH, Chen HL  
  https://www.ncbi.nlm.nih.gov/pubmed/27044007  
 
 

Abstract

Despite immunoprophylaxis, hepatitis B virus (HBV) transmission in highly viremic mothers remains a global health issue. Using quantitative maternal surface antigen (HBsAg) to predict HBV infection in infants has not been investigated. We enrolled 526 mother-infant pairs with positive maternal HBsAg under current immunoprophylaxis. Maternal viral load and quantitative HBsAg were measured in the peripartum period. Infant HBsAg seropositivity for more than 6 months was defined as chronic infection. Rates of chronic infection in infants at various maternal HBsAg levels were estimated using a multivariate logistic regression model. Results showed that maternal HBsAg was positively correlated with maternal viral load (r = 0.69; P < 0.001) and accurately predicted maternal viral load above 6, 7, and 8 log10 IU/mL with an area under the receiver operating characteristic curve (AUC) of 0.97, 0.98, and 0.95. Nineteen infants were chronically infected. After adjustment for the other risk factor, maternal HBsAg level was significantly associated with risk of infection (adjusted odds ratio for each log10 IU/mL increase, 15.02; 95% confidence interval [CI], 3.89-57.94; P < 0.001). The AUC for predicting infection by quantitative maternal HBsAg was comparable to that by maternal viral load (0.89 vs. 0.87; P = 0.459). Estimated rates of infection at maternal HBsAg levels of 4, 4.5, and 5 log10 IU/mL were 2.4% (95% CI, 0.1-4.6; P = 0.04), 8.6% (95% CI, 4.5-12.7; P < 0.001), and 26.4% (95% CI, 12.6-40.2; P < 0.001).

CONCLUSION:

Quantitative maternal HBsAg predicts infection in infants as well as maternal viral load does. Antiviral therapy may be considered in pregnant women with an HBsAg level above 4-4.5 log10 IU/mL to interrupt mother-to-infant transmission. (Hepatology 2016;64:1451-1461). 

 
Question posée
 
La mesure quantitative de l’AgHBs est-elle prédictive de la transmission de l’infection virale B à l’enfant chez les mères ayant une charge virale B élevée ?
 
Question posée
 
Dans une population asiatique, le taux d’AgHBs et celui d’ADN du VHB sont aussi bien prédictifs du risque de transmission du VHB à l’enfant. Dans cette étude, le taux d’AgHBS de 4 à 4,5Log IU/ml était le seuil à retenir pour débuter un traitement anti-viral B au 3ième trimestre.
 
Commentaires

En fonction de la disponibilité des dosages mais en France, l’ADN du VHB reste la référence, en l’absence d’études ciblées.

 
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