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

Abstract

Conclusion. Anti-HBc positivity in HBsAg-negative patients is a sign of previous HBV infection and does not indicate chronic hepatitis. In these patients, anti-TNF␣ therapy appears to be quite safe, as no HBV reactivation was found in our study. Nevertheless, careful monitoring is necessary.

A false occult hepatitis B virus infection developed in a patient with psoriatic arthritis under infliximab and methotrexate therapy

“…In active carriers, antiviral therapy (entecavir/tenofovir) should be started 1-2 weeks before biological treatment and should be provided for at least 12 months after the biological treatment has been interrupted; in inactive carriers, prophylaxis with lamivudine should be recommended and provided for at least further 6 months after the biological therapy has been stopped; in patients affected by OBI, it should be enough to monitor at Notarnicola, F. Iannone, G. Lopalco, M. Covelli, G. Lapadula least every 3 months HBs Ag, anti-HBs Ag, AST and ALT levels. Supporting the idea of the safety of TNF-α blockade in antiHBc alone carriers (true OBI), a prospective study involving a large series of HBs Ag-negative, anti-HBc-positive patients followed for >3 years during anti TNF-α treatment not combined with lamivudine showed no signs of viral reactivation (10). For the OBI carriers, the decline of the HBs-Ab levels represents a warning of possible viral reactivation and it generally anticipates the sero-reversion that is the reappearance of HBs Ag.…”

Biological Therapy and Infection in Rheumatoid Arthritis Patients: Modern Aspects

“…По данным литературы последних 5 лет, частота HBV-носительства среди больных РА и спондило-артропатиями колеблется от 10 до 66% [67][68][69][70][71][72]. С другой стороны, случаи реактивации HBV-инфекции описаны для всех ГИБП, включая развитие фульминантного гепа-тита у больных РА и болезнью Стилла на фоне терапии ИНФ [73,74].…”

Dr. Kato and Dr. Atsumi reply

“…Although reactivation of resolved HBV is a rare complication in rheumatic diseases 3,4,5,6,7,8,9 , high mortality (100% if fulminant hepatic failure develops) is of great clinical significance in this complication 10 , making us watchful for it in all patients with resolved HBV infection. There has been much less evidence regarding reactivation of resolved HBV in the field of rheumatology compared to that in oncology or transplantation.…”

“…There has been much less evidence regarding reactivation of resolved HBV in the field of rheumatology compared to that in oncology or transplantation. In addition, most studies regarding reactivation of resolved HBV in rheumatology were conducted only in patients with RA or spondyloarthropathy 3,4,5,6,7,8,9 . In contrast to other studies, ours enrolled patients with various autoimmune diseases such as systemic lupus erythematosus, vasculitis syndrome, RA, polymyositis/dermatomyositis, idiopathic thrombocytopenic purpura, adult-onset Still's disease, and autoimmune hemolytic anemia, and many patients needed intensive immunosuppressive therapy such as steroid-pulse therapy in a combination with cyclophosphamide.…”