Efficacy of Tenofovir Disoproxil Fumarate in Preventing Vertical Transmission of Hepatitis B in Mothers with Chronic Hepatitis B

Abstract

Introduction: Vertical transmission of the Hepatitis B virus (HBV) from mother to child remains a significant global health concern. Tenofovir Disoproxil Fumarate (TDF) has emerged as a key prophylactic treatment to prevent mother-to-child transmission (MTCT). This review synthesizes current evidence on the efficacy, safety, and optimal use of TDF and its alternative, Tenofovir Alafenamide Fumarate (TAF), in pregnant women with chronic Hepatitis B.

Methods: This review analyzes findings from multiple studies, including a critical review of management strategies , a prospective cohort study on the timing of TDF initiation in resource-limited settings , a systematic review and meta-analysis comparing TDF with immune prophylaxis , a prospective study on the efficacy of TAF , and a national cohort study on TDF use in immunocompromised pregnant women.

Results: TDF is effective in reducing HBV DNA levels and significantly lowers perinatal transmission rates, particularly in HBeAg-positive mothers with high viral loads, proving superior to immune prophylaxis alone. Initial concerns about neonatal bone mineral content have been largely refuted, establishing a favorable safety profile for TDF during pregnancy. TAF has shown similar efficacy with an improved safety profile. In immunocompromised women, TDF is effective in preventing viral reactivation.

Discussion: Discrepancies exist in guidelines regarding the optimal duration of postpartum TDF prophylaxis. While TDF's efficacy is established, some conflicting trial results highlight the need for further research to define specific populations that benefit most. The introduction of TAF presents a promising and potentially safer alternative, though more data on its use in pregnancy is required. Challenges in adherence and implementation, especially in low-resource settings, remain a key consideration.

Conclusion: The literature confirms TDF's vital role in preventing the vertical transmission of HBV. However, uncertainties regarding optimal treatment protocols persist. Ongoing research is crucial to refine guidelines, explore the full potential of alternatives like TAF, and ensure safe and effective interventions for all pregnant women with chronic Hepatitis B.