Mother-to-child transmission of hepatitis B occurs frequently either in the uterus, through placental leakage, or through exposure to blood or blood-contaminated fluids at or around the time of birth. This form of transmission (sometimes called “vertical transmission”) is believed to account for between a third and a half of hepatitis B infections, and so a way to easily prevent it would do a huge amount to reduce the number of people living with hepatitis B in the long term.
Early results from a randomised Chinese clinical trial have shown a possible way to make this happen. Using the medication known as maternal tenofovir disoproxil fumarate (TDF) in combination with infant vaccination against hepatitis B completely eliminated vertical transmission of the hepatitis B virus. This was the case even when the mothers had extremely high loads of hepatitis B virus in their blood.
Another exciting aspect to this trial is that there was no need to use hepatitis B immunoglobulin, something which is often used to give people a temporary immunity against hepatitis B in high-risk situations, or immediately after exposure as a form of prophylaxis. Supply of this immunoglobulin is often very limited, and so anything which reduces demand is extremely helpful.
The mothers themselves also showed dramatically lowered levels of hepatitis B in their blood at the time of birth, and there was no increase in the risk of congenital defects.
Dr Calvin Pan told an audience at The Liver Meeting, one of North America’s largest hepatology conferences, that the findings showed that use of this two-part treatment “could effectively prevent transmission, which is comparable to the current standard of care, with no safety signals.”
This sort of 100% success rate is extraordinarily rare in medical trials, and so further larger trials are now needed to confirm and extend these results.
Australian policy makers must act to reduce the spread of blood-borne viruses (BBVs) in prisons or we won’t be able to achieve critical public health goals like eliminating hepatitis C. This was the call in a consensus statement released by the Harm Reduction in Prisons Working Group.
Moorundi Aboriginal Controlled Health Service will soon be offering hepatitis C point of care testing (POCT) to the community, along with its new Clean Needle Program (CNP) at the service’s Murray Bridge site. The initiative is part of a push to bring hepatitis rapid testing to regional South Australia, under the umbrella of the world-first National Australia HCV Point of Care Testing Program (HCVPOCT).
The newly released 2022 annual report from the Burnet and Kirby institutes, Australia’s Progress Towards Hepatitis C Elimination, has a story of mixed success to tell.
Unrestricted access to direct-acting antivirals (DAAs) through public subsidy since March 2016 means there is a real opportunity to reach the official government target of eliminating hepatitis C as a public health threat in Australia by 2030.
Prof. Satdarshan Singh Monga discusses his team’s investigation into liver regeneration as an alternative to waiting for a transplant
The liver is known for its ability to regenerate (see last issue’s cover story for more information). It can completely regrow itself even after two-thirds of its mass has been surgically removed. But damage from medications, alcohol abuse or obesity can eventually cause the liver to fail. Currently, the only effective treatment for end-stage liver disease is transplantation.
For Jake (name changed for privacy reasons), managing hepatitis C and taking care of his liver health has been a long journey, but every step has been worthwhile. Jake has mild haemophilia. He first found out he had hepatitis C as a young boy in the 1980s when the children’s hospital called him in for testing. At the time he was more worried that he might have HIV, as that was a big concern for people with haemophilia. This is his story as told to Haemophilia Foundation Australia.