vol 13, No.1 (2026)
The Masked Threat of Pre-Core Mutants in Pregnancy: High Viral Replication Despite HBeAg Negativity in an Algerian Cohort ( http://doi.org/10.65613/742338)
2026
Abstract:
Background: Vertical transmission of Hepatitis B virus (HBV) remains the primary driver of chronic infection. Accurate assessment of maternal viral replication and timely prenatal screening are essential to prevent perinatal spread. This study investigated HBsAg seroprevalence, maternal clinico-biological profiles, transmission risk factors, and gestational screening timelines in pregnant women in Eastern Algeria.
Methods: A two-year retrospective cohort study (January 2024–December 2025) was conducted at the University Hospital Center Dr. Benbadis of Constantine, Algeria. Clinical, serological, molecular (quantitative real-time PCR), and biochemical parameters were collected from confirmed HBsAg-positive pregnant women and analyzed using SPSS v21.
Results: Among 10,135 pregnant women screened, 50 were confirmed HBsAg-positive (period prevalence: 0.49%). Mean maternal age was 32.5 years (54% aged 30–39 years), and 52% were multigravida. Primary exposure risk factors included invasive dental care (52%), prior surgery (26%), traditional hijama (18%), and blood transfusion (14%). Screening timing was critically delayed: 48% of cases were screened in the third trimester (27–40 weeks) and 8% at delivery. Serologically, 100% were total anti-HBc-positive, 32% HBeAg-positive, and 68% anti-HBe-positive. HBV DNA was quantified in 56% (n=28); among them, 20% of the total cohort exhibited high viremia (2 × 10⁴ to 2 × 10⁸ IU/mL) requiring antiviral prophylaxis, which was initiated with Tenofovir in 14%. Hepatic transaminases were normal in 82% and prothrombin time was preserved in 68% of patients.
Conclusion: Chronic HBV carriage in pregnant women in this cohort is characterized by a strong predominance of HBeAg-negative profiles yet high active viral replication driven by regional pre-core mutants. Relying solely on HBeAg screening is inadequate to stratify transmission risk. Late third-trimester diagnosis severely limits the therapeutic window for maternal antiviral prophylaxis. Universal first-trimester screening and routine access to quantitative HBV PCR are urgently required to eliminate vertical transmission.
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