Tenofovir in mothers plus HBIG in infants best prevent vertical HBV transmission

For mothers with hepatitis B virus (HBV) infection who are positive for both hepatitis B surface and envelope antigens, administering a combination of hepatitis B vaccine and immunoglobulin (HBIG) in their infants plus tenofovir disoproxil fumarate (TDF) in the mothers themselves appears to be the best approach for preventing vertical disease transmission, according to a study.

Researchers performed a systematic review and meta-analysis of randomized controlled trials that were conducted in HBsAg(+) pregnant women and evaluated the effect of the treatment combinations HBV vaccine, HBIG, and antiviral treatments (eg, lamivudine, telbivudine, TDF) on the primary outcome of vertical transmission of HBV.

Vertical transmission was defined as HBsAg(+) or detectable levels of HBV DNA in infants aged 6–12 months. Secondary outcomes were efficacy in infants.

A total of 19 studies were included in the meta-analysis. Pooled data showed that a combination of HBIG in infants was superior to vaccination alone in terms of reducing the risk of HBV transmission in the infants of mothers who were positive for both HBsAg and HBeAg (risk ratio [RR], 0.52, 95 percent confidence interval [CI], 0.30–0.91).

The addition of maternal TDF further reduced the risk of transmission in infants (RR, 0.10, 95 percent CI 0.03–0.35). This benefit was not observed for the addition of maternal telbivudine or lamivudine.

Meanwhile, for infants of mothers with HBsAg positivity and mixed, unknown, or negative HBeAg, no additional agents provided further benefit beyond hepatitis B vaccination alone.