Medicine, Dentistry & Health Sciences Collected Works - Research Publications

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Author: Giles, Michelle ×

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    Chronic Hepatitis B Infection and Pregnancy
    Giles, ML ; Visvanathan, K ; Lewin, SR ; Sasadeusz, J (LIPPINCOTT WILLIAMS & WILKINS, 2012-01)
    UNLABELLED: It is estimated that 350 to 400 million individuals worldwide are chronically infected with hepatitis B virus (HBV). In regions of high endemicity, many of these are females of reproductive age who are an important source for perinatal transmission. There are a number of issues specific to the women of childbearing age who have chronic HBV infection, including the safety of antiviral therapy during pregnancy and breast-feeding, the changes in the immune system during pregnancy and postpartum that may impact on the natural history of HBV, and the emerging role of antivirals to reduce perinatal transmission of HBV. For women in their reproductive years who require treatment, many of the available antivirals have not been studied in pregnant or breast-feeding women and their use requires the development of a carefully considered strategy, considering the impact of both the disease and treatment on the mother and fetus/infant. The purpose of this article is to (1) review data regarding the mechanisms and timing of perinatal HBV infection; (2) review data on interventions, particularly antiviral therapy, to reduce perinatal transmission beyond the protection afforded by hepatitis B immunoglobulin and vaccination; (3) summarize the immunological changes associated with pregnancy and the potential effect these may have on the natural history of HBV infection; and (4) summarize the information currently available for antiviral therapy available for HBV treatment, focusing specifically on safety data pertaining to reproduction, pregnancy, and breast-feeding. TARGET AUDIENCE: Obstetricians & Gynecologists and Family Physicians. LEARNING OBJECTIVES: After completing this CME activity physicians should be better able to classify the interventions to reduce mother-to-child transmission of hepatitis B including antivirals, caesarean section, hepatitis B immunoglobulin and hepatitis B vaccine, assess the immunological changes associated with pregnancy and the potential effect this may have on the natural history of HBV infection and apply the information currently available for antiviral therapy licensed for HBV treatment, focusing specifically on safety data in pregnancy and during breastfeeding.
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    TLR2 AND TLR7/8 ACTIVATION PREDICT POST PARTUM HBV FLARES
    Visvanathan, K ; Skinner, N ; Locarnini, S ; Bowden, S ; Lewin, S ; Giles, M ; Sasadeusz, J (ELSEVIER SCIENCE BV, 2012-04)
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    CLINICAL OUTCOMES, VIROLOGICAL CHANGES AND FLARES IN WOMEN WITH CHRONIC HEPATITIS B VIRUS INFECTION DURING PREGNANCY AND POST PARTUM
    Giles, M ; Visvanathan, K ; Lewin, S ; Spelman, T ; Locarnini, S ; Bowden, S ; Sasadeusz, J (ELSEVIER SCIENCE BV, 2012-04)
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    Clinical and virological predictors of hepatic flares in pregnant women with chronic hepatitis B
    Giles, M ; Visvanathan, K ; Lewin, S ; Bowden, S ; Locarnini, S ; Spelman, T ; Sasadeusz, J (BMJ PUBLISHING GROUP, 2015-11)
    BACKGROUND: Unique immunological changes occur during pregnancy; the impact of which, on virological and biochemical markers of hepatitis B infection is not well established. Rapid changes in the immunological profile post partum and consequent rebound of the inflammatory response may result in hepatic flares. METHODS: Women with chronic hepatitis B were recruited during pregnancy into this observational study. Demographic and clinical data were collected together with virological and biochemical parameters at two time points during pregnancy (early and late) and two time points post partum (between 6 weeks and 12 weeks and at 12 months). Outcomes analysed included changes in HBV DNA, hepatitis B e antigen (HBeAg) status and flares of hepatitis. RESULTS: One hundred and twenty-six women were recruited. Twenty-seven women out of 108 with postpartum bloods (25%) met our definition of a postpartum flare (ALT range 38-1654). Using univariate analysis HBeAg status, younger age, gravida and parity were associated with a flare. On multivariate analysis HBeAg positivity at baseline fell just outside of statistical significance in predicting a postpartum flare (p=0.051). CONCLUSIONS: 25% of women with chronic hepatitis B will demonstrate increased liver inflammation in the postpartum period. This is usually asymptomatic and resolves spontaneously. This is more likely if the woman is HBeAg-positive at baseline (2.56 times the risk), although flares also commonly occur in HBeAg-negative women.