Prevention of mother-to-child transmission of hepatitis B virus and hepatitis C virus

Abstract

About 240 million people worldwide are chronically infected with hepatitis B virus (HBV). Vertical transmission is the most important mechanism of infection persistence in endemic areas. About 150 million people worldwide are chronically infected with hepatitis C virus (HCV). Mother-to-child transmission of HCV, which occurs in 3–10% of cases, is the leading route of infection in childhood. This review focuses on strategies to reduce the vertical transmission of HBV and HCV. The at-birth prophylaxis of newborns of HBV-infected mothers with specific immunoglobulin and vaccine plus administration of antivirals (tenofovir or telbivudine) in the third trimester of pregnancy (in case of high maternal viral load) greatly reduces the risk of transmission. In contrast, currently there is no drug able to reduce the vertical transmission of HCV infection. We discuss the possibility of reducing mother-to-child HCV transmission using newly available antivirals or antivirals in the pipeline for the treatment of hepatitis C.

Keywords::

• antivirals
• new drugs
• prophylaxis
• screening
• telbivudine
• tenofovir
• vertical transmission

Acknowledgement

The authors thank JA Gilder (Scientific Communication srl., Naples, Italy) for text editing.

Financial & competing interests disclosure

The work was partially funded by Fellowship Program ‘Monitoraggio e gestione clinico-farmacologica delle gravide HBV-positive. Studio prospettico’ (Gilead Sciences). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• As many as 240 million people and 150 million people are chronically infected with hepatitis B virus (HBV) or hepatitis C virus (HCV), respectively.

• Vertical transmission, especially of HBV, helps to perpetuate the infection in high-prevalence areas.

• Without prophylaxis, the risk of vertical transmission of HBV is 70–90% in hepatitis B e antigen-positive mothers and 10–40% in hepatitis B e antigen-negative mothers, while the risk of vertical transmission of HCV is between 3 and 10%.

• For HBV vertical transmission, the at-birth administration of specific immunoglobulin and vaccine reduces the risk to about 3%. For high viremic mothers, additional prophylaxis with class B antiviral drugs (tenofovir or telbivudine) during the third trimester of pregnancy can be considered.

• For HCV infection, no drug is indicated in this setting and non-pharmacological approaches (e.g., elective cesarean section) are not effective in preventing vertical transmission.

• In the future, it may be possible to administer the new antivirals active against HCV during pregnancy to prevent HCV vertical transmission. Studies in this setting are warranted.