富马酸替诺福韦预防乙型肝炎垂直传播的作用

IF 1.3 4区 医学 Q4 INFECTIOUS DISEASES Antiviral Therapy Pub Date : 2022-04-01 DOI:10.1177/13596535221076640
C. Pan
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引用次数: 2

摘要

背景:由于如果母体血清乙型肝炎病毒(HBV)DNA水平大于200000 IU/ml,则可能发生免疫预防失败,因此研究了富马酸替诺福韦二酯(TDF)治疗预防母婴传播(PMTCT)的方法。方法在PUBMED、EMBASE、Cochrane、CNKI和万方数据库中检索2015年1月1日至21年7月1日期间母体TDF治疗PMTCT的文献。从英文或中文的随机对照试验中提取数据并进行审查。感兴趣的结果包括TDF与安慰剂治疗PMTCT的疗效和安全性。结果在数据库中确定的11项随机对照试验中,偏倚的风险较低。所有研究都表明,从妊娠中期或晚期开始对高病毒血症的慢性乙型肝炎母亲进行的母体TDF治疗对HBV的PMTCT是非常有效和安全的,但在泰国进行的一项随机对照试验显示,与安慰剂相比,TDF治疗在PMTCT方面没有任何治疗优势(0%对3%的传播)。最近出现的数据表明,在HBV DNA>200000 IU/ml的母亲中,在妊娠中期或晚期早期开始的母体TDF治疗在分娩前实现了病毒血症控制。在为期4年的母体TDF治疗随访研究中,胎儿接触TDF后对婴儿的身体生长、心理或精神发育以及骨密度没有影响。根据随机对照试验的最新疗效和安全性数据,提出了一种算法。讨论了资源限制领域的做法。结论TDF作为治疗高病毒血症母亲PMTCT的首选疗法,对母亲和婴儿都是安全的。TDF应在妊娠中期或晚期早期开始,结合适当的婴儿免疫预防。
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The role of tenofovir disoproxil fumarate for preventing vertical transmission of hepatitis B
Background Since immunoprophylaxis failure can occur if maternal serum hepatitis B virus (HBV) DNA levels are >200,000 IU/ml, tenofovir disoproxil fumarate (TDF) therapy has been investigated for preventing mother to child transmission (PMTCT). Methods A literature search for maternal TDF therapy for PMTCT between 1/1/2015 and 7/1/21 on PUBMED, EMBASE, Cochrane, CNKI, and Wanfang databases was performed. Data from RCTs in English or Chinese were extracted and reviewed. The outcomes of interest included the efficacy and safety of TDF versus placebo for PMTCT. Results Among 11 RCTs identified from the databases, the risk-of-bias was low. All studies demonstrated that maternal TDF therapy initiated from the second or third trimester for highly viremic chronic hepatitis B mothers is highly effective and safe in the PMTCT of HBV, except one RCT performed in Thailand which showed no therapeutic advantage on TDF treatment versus placebo for PMTCT (0% vs 3% transmission). Recent emerging data suggest that maternal TDF therapy initiated at the 2nd or early 3rd trimester in mothers with HBV DNA >200,000 IU/ml achieved viremic control before delivery. In the 4-year long follow-up study for maternal TDF therapy, there were no impacts on infants’ physical growth, psychological or mental development, and bone mineral density after fetal exposure to TDF. In the light of updated efficacy and safety data from RCTs, an algorithm was proposed. The approaches in resource-limit areas were discussed. Conclusions TDF is safe for both mothers and infants as the preferred therapy for PMTCT in highly viremic mothers. TDF should be initiated at the second or early third trimester in the combination of the appropriate infants’ immunoprophylaxis.
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来源期刊
Antiviral Therapy
Antiviral Therapy 医学-病毒学
CiteScore
2.60
自引率
8.30%
发文量
35
审稿时长
4-8 weeks
期刊介绍: Antiviral Therapy (an official publication of the International Society of Antiviral Research) is an international, peer-reviewed journal devoted to publishing articles on the clinical development and use of antiviral agents and vaccines, and the treatment of all viral diseases. Antiviral Therapy is one of the leading journals in virology and infectious diseases. The journal is comprehensive, and publishes articles concerning all clinical aspects of antiviral therapy. It features editorials, original research papers, specially commissioned review articles, letters and book reviews. The journal is aimed at physicians and specialists interested in clinical and basic research.
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