Prevention of mother-to-child transmission of hepatitis B virus: protocol for a one-arm, open-label intervention study to estimate the optimal timing of tenofovir in pregnancy

Marieke Bierhoff, Kenrad E Nelson, Nan Guo, Yuanxi Jia, Chaisiri Angkurawaranon, Podjanee Jittamala, Verena Carrara, Wanitda Watthanaworawit, Clare Ling, Fuanglada Tongprasert, Michele van Vugt, Marcus Rijken, Francois Nosten, Rose McGready, Stephan Ehrhardt, Chloe Lynne Thio, Marieke Bierhoff, Kenrad E Nelson, Nan Guo, Yuanxi Jia, Chaisiri Angkurawaranon, Podjanee Jittamala, Verena Carrara, Wanitda Watthanaworawit, Clare Ling, Fuanglada Tongprasert, Michele van Vugt, Marcus Rijken, Francois Nosten, Rose McGready, Stephan Ehrhardt, Chloe Lynne Thio

Abstract

Introduction: Hepatitis B virus (HBV) remains a public health threat and the main route of transmission is from mother to child (MTCT). Tenofovir disoproxil fumarate (TDF) treatment can reduce MTCT of HBV although the optimal timing to attain undetectable HBV DNA concentrations at delivery is unknown. This protocol describes the procedures following early initiation of maternal TDF prior to 20 weeks gestation to determine efficacy, safety and feasibility of this approach in a limited-resource setting.

Methods and analyses: One hundred and seventy pregnant women from the Thailand-Myanmar border between 12 and <20 weeks gestational age will be enrolled into a one-arm, open-label, TDF treatment study with cessation of TDF 1 month after delivery. Sampling occurs monthly prenatal, at birth and at 1, 2, 4 and 6 months post partum. Measurement of tenofovir concentrations in maternal and cord plasma is anticipated in 10-15 women who have detectable HBV DNA at delivery and matched to 20-30 women with no detectable HBV DNA. Infant HBsAg status will be determined at 2 months of age and HBV DNA confirmed in HBsAg positive cases. Adverse events including risk of flare and adherence, based on pill count and questionnaire, will be monitored. Infants will receive HBV vaccinations at birth, 2, 4 and 6 months and hepatitis B immunoglobulin at birth if the mother is hepatitis B e antigen positive. Infant growth and neurodevelopment at 6 months will be compared with established local norms.

Ethics and dissemination: This study has ethical approval by the Ethics Committee of the Faculty of Tropical Medicine, Mahidol University (FTM ECF-019-06), Johns Hopkins University (IRB no: 00007432), Chiang Mai University (FAM-2559-04227), Oxford Tropical Research Ethics Committee (OxTREC Reference: 49-16) and by the local Tak Community Advisory Board (TCAB-02/REV/2016). The article will be published as an open-access publication.

Trial registration number: NCT02995005, Pre-results.

Keywords: fetal medicine; maternal medicine; public health; therapeutics; tropical medicine; virology.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.

Figures

Figure 1
Figure 1
Map of the central office of Shoklo Malaria Research Unit in Mae Sot, and the study sites Wang Pha (WPA), Mawker Thai (MKT) and Maela (MLA) on the Myanmar–Thailand border where the study will be conducted.
Figure 2
Figure 2
Schematic reproduction of the study design. ALT, alanine aminotransferase; Cr, creatinine; EGA, estimated gestational age; HBeAg, hepatitis B envelope antigen; HBIG, hepatitis B immunoglobulins; HBsAg, hepatitis B surface antigen; HBV, hepatitis B virus; TDF, tenofovir disoproxil fumarate.

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