Frequency of Hepatitis B Markers in Systemic Lupus Erythematosus Patients in Iran

Abstract

Background: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease. Hepatitis B virus is the causative agent for chronic, acute, cirrhosis, and hepatocellular carcinoma. SLE patients with chronic or occult hepatitis B infection undergoing immunosuppressive drugs may become reactive and develop fatal hepatitis. Therefore, this study was conducted to determine HBV markers in SLE patients before the administration of immunosuppressive drugs in Ahvaz city, Iran. Materials and methods: The sera of 92 SLE patients were tested for HBs Ag and anti-HBc using ELISA, HBV DNA (by Nested PCR) testes. Real-time PCR was performed for the patients with positive anti-HBc and negative HBsAg. The positive HBV DNA samples were checked for HBV genotype and HBV subtypes. Results: Among the 92 SLE patients, three (3.3%) were males and 89 (96.7%) females . The patients' ages ranged from 14 to 70 years [mean age of 38.9±10.1]. Three of 92 (3.26%) subjects [2/3 males and 1/89 female] were positive for HBsAg, anti-HBc Ab, and HBV DNA detected with PCR (p=0.000003)]. Five of 89 (5.61%) subjects [1 male and 4/88 females were only positive for anti-HBc and negative for HBs Ag, HBV DNA(PCR) using Real-time PCR (p=0.05). The results of the nucleotide data and phylogenetic tree showed all three HBV patients were genotype D1. The results of amino acid sequencing revealed all three HBV patients were HBV subtype ayw2. Conclusion: This study proved that 3.26% of SLE patients were positive for overt HBV infection (positive for anti-HBc, HBsAg and HBV-DNA using PCR). All the three isolated HBV were genotype D1 and subtype ayw2. The fact that 5.61% of the patients were only positive for anti-HBc characterized the occult hepatitis B infection (OBI) although further investigation is needed. To prevent HBV or OBI reactivation for SLE patients before immunosuppression treatment, HBV markers including anti-HBc, HBsAg, HBV-DNA should be implemented using PCR and Real-time PCR .

Systemic lupus erythematosus is associated with lower risk of hepatitis B virus infection: A multivariable Mendelian randomization study in East Asian population

“…Autoimmune diseases have been closely linked to viral infections, with studies connecting Epstein−Barr virus to SLE and rheumatoid arthritis (RA) 8 . Over several decades, a multitude of studies have reported a potential association between SLE and HBV infection, with the majority of observational studies demonstrating a reduced HBV infection rate among SLE patients 9–11 . Some observational studies support the notion that SLE may decrease the risk of HBV infection, 10 while others suggest that HBV may exert a protective effect on SLE 12,13 .…”

“…studies have reported a potential association between SLE and HBV infection, with the majority of observational studies demonstrating a reduced HBV infection rate among SLE patients. [9][10][11] Some observational studies support the notion that SLE may decrease the risk of HBV infection, 10 while others suggest that HBV may exert a protective effect on SLE. 12,13 Traditional research approaches are hindered by confounding variables and reverse causation, making it difficult to establish a causal relationship between SLE and HBV.…”