Table 1International recommendations for prevention of mother-to-child transmission (PMTCT) using antiviral therapy

International guidelines for PMTCTFDA categoryComment
AASLD1EASL2APASL3
Adefovir dipivoxil (ADV)NDNDNDC-
Emtricitabine (FTC)NDNDNDB-
Entecavir (ETV)NDNDNDC-
Lamivudine (3TC/LAM)+++C-
Telbivudine (LdT)+++++B-
Tenofovir alafenamide fumarate (TAF)NDNDNDND-
Tenofovir disoproxil fumarate (TDF)+++++++++B-
Comment-----

+: Presented in the guidelines; +++: presented as a recommended agent; ND: not described

1

“The only antivirals studied in pregnant women are lamivudine, telbivudine, and TDF. Of these three options, TDF is preferred to minimize the risk of emergence of viral resistance during treatment. Interim studies show high efficacy of TDF in preventing MTCT.” (a quotation from the respective guidelines)

2

“Reproduction studies have been performed in animal and in humans with TDF and LdT and revealed no evidence of harm to the fetus due to these drugs. Among the last two agents, TDF should be preferred, because it has a better resistance profile and more extensive safety data in pregnant HBV-positive women.” (a quotation from the respective guidelines)

3

For reduction of the risk of mother-to-infant transmission that occurs during the perinatal period, short-term maternal nucleoside analogues (NAs) starting from 28 to 32 weeks of gestation is recommended using either tenofovir or telbuvidine for those mothers with HBV DNA above 6–7 log10 IU/mL. In pregnant women with chronic HBV infection who need antiviral therapy, tenofovir is the drug of choice for mothers indicated for antiviral treatment during the first through third trimester of pregnancy. It is a pregnancy category B drug with adequate safety data in HIV-positive women and least chance of viral resistance.

From: Web Annex A, Systematic review of the efficacy and safety of antiviral therapy during pregnancy

Cover of Prevention of Mother-to-Child Transmission of Hepatitis B Virus: Guidelines on Antiviral Prophylaxis in Pregnancy
Prevention of Mother-to-Child Transmission of Hepatitis B Virus: Guidelines on Antiviral Prophylaxis in Pregnancy.
Geneva: World Health Organization; 2020 Jul.
© World Health Organization 2020.

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