— Christine M. Kukka, Project Manager, HBV Advocate
A U.S. Centers for Disease Control and Prevention study, published in the journal Infectious Diseases in Obstetrics and Gynecology, found a large discrepancy in medical treatment for women with hepatitis B-related liver disease.
While scientific evidence shows antivirals are
safe in pregnant women and effectively lower the risk of mother-to-child
infection, American doctors prescribed antivirals to only 12.6% of
pregnant women infected with the hepatitis B virus (HBV). In contrast,
they prescribed antivirals to 20% of non-pregnant women.
The important study examined prescription records
of 17 million, privately-insured women in 2011. Researchers identified
6,274 women in the study group who were HBV-infected and examined what
drugs were prescribed to treat their liver disease.
Pregnant women were most commonly prescribed the
antivirals tenofovir (Viread) (73.4%) and lamivudine (Epivir-HBV)
(21.9%). The high rate of lamivudine usage is surprising–lamivudine has
a high rate of drug resistance and is no longer recommended as a
first-line treatment for any patient.
Currently tenofovir and entecavir (Baraclude) are
the top two recommended antivirals because of their safety, potency,
and low rates of drug resistance.
Among 48 treated pregnant women:
- 16 (33.3%) were prescribed an antiviral before
pregnancy and continued treatment for at least one month after
delivery. Many women with HBV experience liver-damaging "flares" after
childbirth and monitoring and treatment is important during the
post-partum period.
- 14 (29.2%) started treatment during the third
trimester of their pregnancy–probably to lower viral load to avoid
infecting their newborn–and continued antiviral treatment for at least
one month after delivery.
Nonpregnant women were most
commonly prescribed tenofovir (50.2%) and entecavir (41.3%), as is
recommended by current medical guidelines. Surprisingly, these female
patients with liver disease had a better chance of getting treatment if
they lived in the South, compared to patients living in the Northeast
region of the U.S.
"Among this insured population, pregnant women
with chronic hepatitis B received an antiviral significantly less often
than nonpregnant women," researchers wrote. The results show the need
to examine doctors' treatment of female patients nationwide, the CDC
officials concluded, and to increase antiviral use in pregnant women to
prevent infection of newborns.
Source: www.ncbi.nlm.nih.gov/pmc/articles/PMC4274824/
Labels: treatment during pregnancy, women quality of care in US
