Unsatisfying antiviral therapeutic effect in patients with mother-to-child transmissed chronic hepatitis B virus infection: a prospective multi-center clinical study

Jun Li, Xiao-Qin Dong, Zhao Wu, An-Lin Ma, Shi-Bin Xie, Xu-Qing Zhang, Zhan-Qing Zhang, Da-Zhi Zhang, Wei-Feng Zhao, Guo Zhang, Jun Cheng, Qing Xie, Jun Li, Zhi-Qiang Zou, Ying-Xia Liu, Gui-Qiang Wang, Hong Zhao, China Hepatitis B Related Fibrosis Assessment Research Group, Jun Li, Xiao-Qin Dong, Zhao Wu, An-Lin Ma, Shi-Bin Xie, Xu-Qing Zhang, Zhan-Qing Zhang, Da-Zhi Zhang, Wei-Feng Zhao, Guo Zhang, Jun Cheng, Qing Xie, Jun Li, Zhi-Qiang Zou, Ying-Xia Liu, Gui-Qiang Wang, Hong Zhao, China Hepatitis B Related Fibrosis Assessment Research Group

Abstract

Background: Few data are available regarding the progression of liver disease and therapeutic efficacy in chronic hepatitis B virus (HBV) carriers infected by mother-to-child transmission (MTCT). This study aimed to investigate these two aspects by comparing the adult chronic HBV carriers in MTCT group with those in horizontal transmission group.

Methods: The 683 adult chronic HBV patients qualified for liver biopsy including 191 with MTCT and 492 with horizontal transmission entered the multi-center prospective study from October 2013 to May 2016. Biopsy results from 217 patients at baseline and 78 weeks post antiviral therapy were collected.

Results: Patients infected by MTCT were more likely to have e antigen positive (68.6% vs. 58.2%, χ = -2.491, P = 0.012) than those with horizontal transmission. However, in patients with MTCT, levels of alkaline phosphatase (ALP) (P = 0.031), Fibroscan (P = 0.013), N-terminal propeptide of Type III procollagen (PIIINP) (P = 0.014), and Laminin (LN) (P = 0.006) were high, in contrast to the patients with horizontal transmission for whom the levels of albumin (ALB) (P = 0.041), matrix metalloproteinase-3 (MMP-3) (P = 0.001) were high. The 47.2% of patients with MTCT and 36.8% of those with horizontal transmission had significant liver fibrosis (P = 0.013). Following antiviral therapy for 78 weeks, 21.2% and 38.0% patients with MTCT and horizontal transmission acquired hepatitis B e antigen (HBeAg) clearance, respectively (P = 0.043), and the virological response rates were 54.7% and 74.1% in the MTCT and horizontal groups, respectively (P = 0.005). MTCT was a risk factor for HBeAg clearance and virological response.

Conclusion: Adult patients with MTCT were more prone to severe liver diseases, and the therapeutic efficacy was relatively poor, which underlined the importance of earlier, long-term treatment and interrupting perinatal transmission.

Trial registration: NCT01962155; https://clinicaltrials.gov.

Figures

Figure 1
Figure 1
The flow chart of study design. CHB: Chronic hepatitis B.
Figure 2
Figure 2
Distributions of (A) different stages of liver fibrosis, (B) the significant fibrosis (F ≥ 3), (C) the moderate to severe inflammation (HAI ≥ 5) and (D) the patients who needed antiviral therapy (F ≥ 3 or HAI ≥ 5) at baseline. 1: Patients with mother-to-child transmission; 2: Patients with horizontal transmission; F: Ishak fibrosis score; HAI: Histology activity index.

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