Unexpected HBsAg decrease after nucleoside analogues re-treatment among HBeAg positive postpartum women: a pilot study.

Abstract Background/Purpose: Mother-to-child transmission (MTCT) is one of the main routes of transmission of HBV, and previous studies focused on the efficacy and safety of nucleoside analogues (NAs) in the prevention MTCT. There are limited data on virologic changes of chronic hepatitis B (CHB) patients after discontinuing treatment postpartum and the efficacy of re-treatment. Methods A retrospective-prospective real-word pilot cohort study on HBeAg-positive pregnant women with chronic HBV infection was conducted. Biochemical and virological characteristics (HBsAg, HBeAg and HBV DNA) in patients received NAs treatment pre-pregnancy (n = 10), patients discontinued treatment after delivery (n = 88) and re-treatment patients (n = 22) were collected during follow-up. Results The incidence of ALT flare was numerically higher in patients discontinued NAs treatment postpartum compared to patients received NAs treatment pre-pregnancy (28.9% versus 0%, P = 0.058). More significantly decreases of HBsAg, HBeAg and HBV DNA were observed in re-treatment patients compared to patients received NAs treatment pre-pregnancy. Significantly higher incidences of half decrease of HBsAg and 0.5 lg decrease of HBsAg were achieved in 95.5% (21/22) and 76.2% (16/21), and numerically higher incidence of HBsAg < 1000 IU/mL was achieved in 36.4% (8/22) in re-treatment patients compared to patients received NAs treatment pre-pregnancy and patients discontinued treatment. Long-term follow-up results indicated that it is safe for HBeAg positive pregnant patients to discontinue treatment after delivery. Conclusion HBeAg positive patients received NAs treatment during pregnancy and discontinued it postpartum can benefit from NAs re-treatment because of unexpected decrease of HBsAg, which may be helpful for achieve the goal of functional cure.