Clinical effect of telbivudine in treatment of pregnant women with hepatitis B virus infection and a low-level increase in alanine aminotransferase

Objective To investigate the clinical effect of antiviral therapy with telbivudine antiviral therapy in parturients with hepatitis B virus ( HBV) infection and a special immune status in pregnancy. Methods A retrospective analysis was performed for the clinical data of67 HBsAg-positive chronic hepatitis B ( CHB) patients with HBV DNA > 106IU/ml who were examined and gave birth in Beijing You An Hospital, Capital Medical University, from January 2014 to October 2015. According to the level of alanine aminotransferase ( ALT) , the patients were divided into ALT < 2 × upper limit of normal ( ULN) group ( 29 patients, group A) , ALT ≥2 × ULN group with antiviral therapy ( 20 patients, group B) , and low-level ALT increase group without antiviral therapy ( 18 patients, group C) . The patients in groups A and B were given antiviral therapy with telbivudine after 12 weeks of pregnancy. The three groups were observed in terms of the levels of HBV markers HBsAg and HBeAg, liver biochemical parameters, adverse drug reactions, and neonatal birth defects. An analysis of variance was used for comparison of continuous data between multiple groups, the chi-square test was used for comparison of categorical data between multiple groups, and the Fisher's exact test was used when the data did not meet the conditions for the chi-square test. Results There were no significant differences between the three groups in normalization rate of liver function and the change in HBsAg level at the time of delivery ( both P > 0. 05) . The proportions of patients who achieved a ≥3 log reduction in HBV DNA level at the time of delivery were 44. 8%, 85. 0%, and 16. 7%, respectively, in the three groups, and the proportions of patients who achieved a ≥50% reduction in HBeAg were 41. 4%, 70. 0%, and 11. 1%, respectively; there were significant differences between the three groups for the two indices ( χ2=19. 85 and 14. 74, both P < 0. 001) . Conclusion The right timing of antiviral therapy for pregnant women with a low-level increase in ALT can effectively reduce the risk of mother-to-child transmission.