What is the role of hepatitis testing in pregnant women with HIV infection?

Updated: Apr 02, 2019
  • Author: Ashley T Peterson, MD; Chief Editor: Ronald M Ramus, MD  more...
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Answer

Hepatitis B surface antigen status testing is recommended for all pregnant women. HIV-infected pregnant women who screen negative for HBV (i.e., HBsAg-negative, anti-HBc-negative, and anti-HBs-negative) should receive the HBV vaccine series. In the case of acute hepatitis B infection (HBV), the risk of vertical transmission also varies with gestational age, with an 80-90% risk of transmission to the offspring if the infection occurs in the third trimester. [23] Women who are co-infected with HIV and chronic hepatitis B may require different management in pregnancy.  Current guidelines recommend tenofovir disoproxil fumarate plus lamivudine or emtricitabine. [24]

Co-infection with HIV and hepatitis C virus (HCV) is common and may range from 17-54%. [25] The diagnosis of hepatitis C is confirmed by identification of the hepatitis C antibody via an ELISA test. False-negative HCV test results may occur if the CD4 count is very low. More specific tests, (eg, hepatitis C viral RNA detection by polymerase chain reaction) are available. High maternal viral titers have been associated with an increased risk of vertical transmission.

Chronic carriers of HBV or HCV should receive education on the importance of informing sexual partners, household contacts, and needle-sharing contacts and review precautions to decrease transmission.


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