A Systematic Review Examining the Outcomes and Mortality of Individuals with Perinatally Acquired Hepatitis B Virus (HBV), with and without HBV Treatment

Background: Over 257 million people were living with chronic hepatitis B in 2015, causing an estimated 887,000 deaths. Vertical transmission is the most common mechanism of transmission resulting in children at risk of developing long-term health conditions. The objectives of this review were to examine and review literature on individuals with perinatally acquired Hepatitis B to improve virological outcomes whilst preventing clinical outcomes.

Methods: A search was conducted in 4 databases (Embase, Medline, Web of Science and Cochrane) in August 2020 to identify eligible studies for this review. Studies included were randomised control trials (RCTs) or observational studies that investigated long-term outcomes of Hepatitis B amongst perinatally infected individuals.

Results: The search strategy produced 1,517 results, of which 9 studies were eligible for inclusion after screening. Most studies were published after 2014 (n = 6), with Asia being the most common study setting (n=4). More papers reported virological outcomes (n=7) than clinical outcomes (n=4). Virological outcomes included: viral load, HBsAg clearance, HBeAg seroconversion and HBeAg loss. Clinical outcomes included: cirrhosis, hepatocellular carcinoma (HCC), liver failure and mortality.

Conclusion: A variety of long term outcomes were identified but information relating outcomes to mode of acquisition was lacking in most studies. The effectiveness of treatment could not be assessed accurately as a result. The research gap identified by this review needs to be addressed to facilitate informed conversations with Hepatitis B positive mothers regarding the long-term risks for their children.