Peripartum ALT flares predict earlier postpartum HBeAg clearance in highly viremic HBV-infected women: A long-term follow-up study.
Wan-Hsin Wen, Chun-Jen Liu, Ming-Wei Lai et al.
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In 30 seconds
This multicentre long-term follow-up study examined postpartum HBeAg clearance in 293 HBeAg-positive pregnant women with high HBV viral loads, enrolled in prior trials of tenofovir for prevention of mother-to-child transmission. ALT trajectories from late pregnancy through six months postpartum were classified as flare or stable. Over a median postpartum follow-up of 27.1 months, 50 women cleared HBeAg. A flare-type ALT trajectory independently predicted earlier clearance (HR 10.37; 95% CI 5.44-19.76; p <0.001), with higher cumulative clearance rates than in the stable group at 12, 24, and 60 months.
Key findings
- Fifty women achieved HBeAg clearance, an incidence of 5.03 per 100 person-years over a median postpartum follow-up of 27.1 months.
- A flare-type peripartum ALT trajectory predicted earlier HBeAg clearance (HR 10.37; 95% CI 5.44-19.76; p <0.001), adjusted for multiple covariates.
- Cumulative clearance in flare versus stable groups was 2.3% vs. 0.4% at 12 months, 25.3% vs. 3.9% at 24 months, and 85.9% vs. 11.9% at 60 months.
- No adverse hepatic outcomes were observed.
Why it matters
The findings link peripartum ALT patterns with the timing of HBeAg clearance in women with high HBV viral loads, extending the focus beyond prevention of mother-to-child transmission. Recognising this association may help clinicians interpret postpartum disease course and consider maternal outcomes when planning follow-up, while the observational follow-up does not establish that ALT flares cause clearance.
What to keep in mind
Postpartum follow-up and antiviral initiation after six months were guided by routine-care reimbursement criteria and shared decision-making, rather than a uniform assigned treatment strategy.