Dear Editor:
A 28 years old pregnant
patient in her 8TH week of pregnancy was admitted due to dizziness,
without fever, vomiting or jaundice, and without signs of hepatic
encephalopathy. Her physical examination was within the normal limit but
laboratory results showed: ALT 900, AST 650, GGT 84, ALK.PH 100; ALBUMIN 4.1,
GLOBULINS 4.2, INR 1.0,
HBsAg +, HBeAg –, HBeAb +, HBcAb
IgM –, HBcAb IgG +, HBV DNA +, HCV Ab –.
I think she have exacerbation of chronic hepatitis B. In this case do
you start treatment with lamivudine?
HS
Dear HS:
This young woman may indeed
have an exacerbation of chronic hepatitis B, presuming that the negative IgM
anti-HBc is a true negative test. Lamivudine is a class C, with theoretically
some small risk to the fetus, but the extensive pregnancy registry established
for patients with HIV infection has not shown any actual fetal risk. On the
other hand, this patient has good synthetic function (and I presume a normal bilirubin)
so follow-up with weekly laboratory checks without therapy may be the most
reasonable approach.