Occult Hepatitis B and Infliximab-induced HBV Reactivation

Safety of tumor necrosis factor α blockers in hepatitis B virus occult carriers (hepatitis B surface antigen negative/anti–hepatitis B core antigen positive) with rheumatic diseases

“…This serologic status corresponds in the majority of cases with complete viral clearance, but a subgroup of patients may present detectable liver HBV DNA, demonstrating asymptomatic HBV replication and defining the status of occult carrier. In accordance with this status, 2 cases of reactivation in HBsAg-negative, antiHBc-positive patients have been described during anti-TNF␣ therapy (15,23). For this reason, the occurrence of HBV reactivation during anti-TNF␣ treatment in anti-HBc carriers is probably unlikely, but it represents a risk that needs to be defined.…”

“…Among HBsAg-positive patients treated with infliximab for Crohn's disease, several cases of HBV reactivation have been described (10 -14), including a case of reactivation in an HBsAg-negative, anti-HBc-positive patient (15). Data from patients treated with TNF␣ blockers for rheumatic diseases show some case reports of HBV reactivation in HBsAg-positive patients as well (16 -22), and a single case of reactivation in an HBsAg-negative and anti-HBc-positive patient (23).…”

Review article: prevention and management of hepatitis B and C infection in patients with inflammatory bowel disease

“…[25][26][27][28][29][30] Table 3 presents a summary of studies reporting reactivation of HBV after infliximab, specifically in patients with IBD (CD in all cases). 7,[31][32][33][34][35][36][37][38] Cases of reactivation after treatment with infliximab have been described in occult carriers of HBV who are negative for HBsAg and positive for anti-HBc antibody 37 (see occult HBV infection, below). Reactivation of HBV infection in HBsAg carriers occurred as soon as after the HBsAg, hepatitis B surface antigen.…”

“…9,36 There is only one report of HBV reactivation in an anti-HBcpositive ⁄ HBsAg-negative patient with CD treated with corticosteroids and infliximab. 37 Therefore, systematic use of anti-viral prophylaxis in anti-HBc-positive patients lacking HBsAg cannot be recommended. 25,36,73 This approach differs from that recommended for patients undergoing chemotherapy, particularly with rituximab.…”

Safety of Anti-Tumor Necrosis Factor Agents in Rheumatic Potential Carriers of Occult Hepatitis B Virus: Table 1.

“…Only 2 case reports of TNF antagonist-related HBV reactivation in HBsAg-negative, anti-HBc-positive patients have been described 4,5 . Kim, et al 1 described 88 patients with potential occult HBV infection, who were found to have a significantly higher risk to develop persistent abnormal liver function tests, compared to the HBcAb-negative group.…”