Prevalence of Hepatitis B Virus Markers in Patients with Autoimmune Inflammatory Rheumatic Diseases in Italy

Abstract

Chronic hepatitis B virus (HBV) infection may be reactivated by immunosuppressive drugs in patients with autoimmune inflammatory rheumatic diseases. This study evaluates HBV serum markers’ prevalence in rheumatic outpatients belonging to Spondyloarthritis, Chronic Arthritis and Connective Tissue Disease diagnostic groups in Italy. The study enrolled 302 subjects, sex ratio (M/F) 0.6, mean age ± standard deviation 57 ± 15 years, 167 (55%) of whom were candidates for immunosuppressive therapy. The Spondyloarthritis group included 146 subjects, Chronic Arthritis 75 and Connective Tissue Disease 83 (two patients had two rheumatic diseases; thus, the sum is 304 instead of 302). Ten subjects (3%) reported previous anti-HBV vaccination and tested positive for anti-HBs alone with a titer still protective (>10 IU/mL). Among the remaining 292 subjects, the prevalence of positivity for HBsAg, isolated anti-HBc, anti-HBc/anti-HBs, and any HBV marker was 2%, 4%, 18%, and 24%, respectively. A total of 26/302 (9%) patients with γ-globulin levels ≤0.7 g/dL were more frequently (p = 0.03455) prescribed immunosuppressive therapy, suggesting a more severe rheumatic disease. A not negligible percentage of rheumatic patients in Italy are at potential risk of HBV reactivation related to immunosuppressive therapy. Before starting treatment, subjects should be tested for HBV markers. Those resulting positive should receive treatment or prophylaxis with Nucleos (t) ides analogue (NUCs) at high barrier of resistance, or pre-emptive therapy, according to the pattern of positive markers. HB vaccination is recommended for those who were never exposed to the virus.

Long-term safety of rituximab in rheumatic patients with previously resolved hepatitis B virus infection

“…Moreover, the time course of monitoring showed a long delay (16 weeks) between the first mild increase in ALT level and the identification of HBsAg seroreversion [23]. The results of our study are in line with our previous data [9] showing both no HBV reactivation, a prevalence of anti-HBc positivity of 14.1%, which is higher than that observed in most Western countries (about 7%) [24] but is similar to that observed by other authors in Italian patients with rheumatic disease [25]. Moreover, we have now also shown that the prHBV status is not associated with RTX treatment discontinuation.…”

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

“…In Our study, we included a full HBV virology panel prior to the commencement of immunosuppressive therapy and during the follow-up period. It should be mentioned that we noticed 43.5 percent of our study cohort were adequately previously immunized with protective antibody titers > 10 IU/L with a higher incidence compared to the recent study done in Italy by Canzoni M et al (2020), in which only 3% were immunized prior to commencement of immunosuppressives, and this may reflect the adequacy of childhood vaccination.…”

Paradoxical HBsAg and anti-HBs coexistence among Chronic HBV Infections: Causes and Consequences

“…Moreover, the coexistence may also occur in the presence of hyperimmune function. As HBV is a common comorbidity among rheumatic patients, HBV infection may reactivate in patients with autoimmune inflammatory rheumatic diseases when they take immunosuppressive drugs or undergo biological therapies 99 , 100 . The HBV infection needs surveillance, and markers like HBsAg and anti-HBs need to be detected before and after the treatment of co-infected diseases.…”