Lack of HBV reactivation among patients receiving immunomodulatory drugs in Egyptian cohort who underwent either close monitoring or Preemptive treatment.

Abstract

Background: HBV reactivation is a preventable disease with high incidence among immunosuppressed. This can be attributed to either HBV virus widespread in the community or an inadequate assessment of HBV status prior to the start of the drug therapy. Materials and strategies:A prospective cohort study included 200 patients with various autoimmune diseases prior to initiation of their immunosuppressives, with a 1 year follow up. Baseline liver biochemicals and HBV virology status were recorded for all patients, and they were arranged into 4 groups (Group A, previously vaccinated; Group B, HBV naïve; Group C, HBV disease and Group D, isolated HBV core). Group A was offered only follow-up, Group B were offered HBV immunization with follow up, and Groups C and D were offered either preemptive therapy or follow-up according to their risk of reactivation. Results: The mean age was 26.5 years (22-34), 58.5% (117 patients) were female, 41.5% (83 patients) were male, our study group included 85 patients with IBD (54 patients with ulcerative colitis and 31 patients with Crohn's disease), 54 patients with SLE, 41 patients with Bechet's disease, 4 patients with rheumatoid arthritis and 16 patients with a variety of other autoimmune diseases. 93.5 % of patients have low risk for reactivation (as HBV status and the commenced drug), 3.5 % were moderate and only 3 % were at high risk. Group A included 43.5% (87 patients). Group B included 47.5 % (95 patients), group C was 4.50% (9 patients) and group D was 4.50% (9 patients). After 1 year follow up, Elevated liver enzymes were found in 10.3%, 20%, 66.7%, 44.4% of patients in group A, B, C and D respectively, pulse steroid therapy and positive HBsAg were the highest predictable values for elevated liver enzymes; However, no patients showed HBVr. Conclusion:Monitoring with a proper assessment is needed for all patients prior to starting immunosuppressives or immunomodulatory drug therapy, there was a low prevalence of HBV among our cohort owing to the effective immunization programs. A close screen with no treatment is seen in HBV core positive patients who are prescribed moderate risk immunosuppressives; HBV core routine screening may be suggested for high-risk immunosuppressives only. HBV vaccine is essential prior to the immunosuppressives and HBsAb titre may not be impacted by the immune system or immunosuppressive medication. Preemptive therapy for HBsAg-positive patients on high-risk immunosuppressives is needed. However, longer follow-up studies with a larger sample size may be required.