Journal of the Chinese Medical Association
Volume 71, Issue 3 , Pages 155-158, March 2008

Lamivudine Therapy in the Treatment of Chronic Hepatitis B with Acute Exacerbation During Pregnancy

  • Jeng-Hsiu Hung

      Affiliations

    • Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
    • National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
    • Corresponding Author InformationCorrespondence to: Dr Jeng-Hsiu Hung, Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, 201, Section 2, Shih-Pai Road, Taipei 112, Taiwan, R.O.C.
    • ,
  • Chi-Jen Chu

      Affiliations

    • Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
    • National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
    • ,
  • Pi-Lin Sung

      Affiliations

    • Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
    • National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
    • ,
  • Chih-Yao Chen

      Affiliations

    • Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
    • National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
    • ,
  • Kuan-Chong Chao

      Affiliations

    • Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
    • National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
    • ,
  • Ming-Jie Yang

      Affiliations

    • Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
    • National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
    • ,
  • Selena Chia-Yi Hung

      Affiliations

    • Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
    • National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.

Received 17 July 2007; accepted 3 December 2007.

Article Outline

We report a case of chronic hepatitis B carrier gravida who had acute exacerbation during pregnancy. She had been taking lamivudine 100 mg/qd for 17 months when hepatitis B virus (HBV) DNA in the YMDD region of the polymerase gene (YMDD motif) mutant was noted. After discontinuing lamivudine, she became pregnant. HBeAg became positive again and liver enzymes were elevated during the first trimester of pregnancy. She received the hepatoprotective agent silymarin 150 mg bid at 13+2 gestational weeks. Serum aspartate aminotransferase (AST) dropped to 757 U/L at 15+0 gestational weeks, but serum alanine aminotransferase (ALT) flared up to 2,230 U/L and AST to 2,250 U/L at 17+1 gestational weeks. Serum HBV-DNA test revealed serum HBV-DNA concentration of 7.31×108 copies/mL. Lamivudine 100 mg/qd and silymarin 150 mg/bid were initiated at 17+1 gestational weeks. Liver function showed gradual decline to ALT 341 U/L and AST 91 U/L at 21+0 gestational weeks, while HBeAg(+) converted to (−) and anti-HBe(−) converted to (+). Further treatment with lamivudine 100 mg/qd continued for 3 months. Serum HBV-DNA concentrations decreased to 3.19×102 copies/mL at 36+6 gestational weeks. Spontaneous delivery of a male baby weighing 3314 g occurred at 38+ ≥ gestational weeks. The neonatal physical check-up revealed no congenital anomalies, and fetal growth was within normal reference ranges, suggesting that lamivudine may be safely used in the treatment of chronic hepatitis B with acute exacerbation during the second trimester of pregnancy.

Key Words:  hepatitis B , lamivudine , pregnancy

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References 

  1. Balfour HH . Antiviral drugs . N Engl J Med . 1999;340:1255–1268
  2. Liaw YF, Sung JJY, Chow WC, Farrell G, Lee CZ, Yuen H, et al  Lamivudine for patients with chronic hepatitis B and advanced liver disease . N Engl J Med . 2004;351:1521–1531
  3. Liu CJ , Kao JH . Hepatitis B virus-related hepatocellular carcinoma: epidemiology and pathogenic role of viral factors . J Chin Med Assoc . 2007;70:141–145
  4. Chen HF , Li CY , Chen P , See TT , Lee HY . Seroprevalence of hepatitis B and C in type 2 diabetic patients . J Chin Med Assoc . 2006;69:146–152
  5. Lan KH . Role of serum quantitative HBV DNA levels in clinical care of CHB patients . J Chin Med Assoc . 2007;70(Suppl):97–98
  6. Riley LE , Yawetz S . Case 32-2005—a 34-year-old HIV-positive woman who desired to become pregnant . N Engl J Med . 2005;353:1725–1732
  7. Tuomala RE, Shapiro DE, Mofenson LM, Bryson Y, Culnane M, Hughes MD, et al  Antiretroviral therapy during pregnancy and the risk of an adverse outcome . N Engl J Med . 2002;346:1863–1870
  8. Watts DH . Management of human immunodeficiency virus infection in pregnancy . N Engl J Med . 2002;346:1879–1891
  9. Su GG , Pan KH , Zhao NF , Fang SH , Yang DH , Zhou Y . Efficacy and safety of lamivudine treatment for chronic hepatitis B in pregnancy . World J Gastroenterol . 2004;10:910–912
  10. Xu XW , Chen YG . Current therapy with nucleoside/nucleotide analogs for patients with chronic hepatitis B . Hepatobiliary Pancreat Dis Int . 2006;5:350–359
  11. Chu CJ . Management of chronic hepatitis B-case interactive challenges . J Chin Med Assoc . 2007;70(Suppl):99–100

PII: S1726-4901(08)70009-1

doi:10.1016/S1726-4901(08)70009-1

Journal of the Chinese Medical Association
Volume 71, Issue 3 , Pages 155-158, March 2008

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