Treatment considerations in patients with concomitant viral infection and autoimmune rheumatic diseases

Louthrenoo, Worawit

doi:10.1016/j.berh.2015.05.010

Cited by 14 publications

(9 citation statements)

References 166 publications

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“…It means that subjects older than this age, similar to those with AIIRD, are at risk of acquiring the virus, as not covered by the vaccine. The potential aggressive clinical course observed in HBV seropositive subjects in case of viral reactivation [7,29] strongly suggests vaccination [6,30,31], for those still HBV seronegative. Higher vaccine doses [32] are advised in case of lacking/defective immune response to the vaccine.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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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.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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“…Moreover, Dmab has proven effective and safe in patients with autoimmune diseases treated with biologics (4). Biologics are safe to use in HIV infected people, if viremia is suppressed and CD4 + T cell count is higher than 200/uL (14). The same principles can be applied to the use of Dmab in this group of patients.…”

Section: Case Reportmentioning

confidence: 98%

Denosumab for the treatment of HIV-associated osteoporosis with fractures in a premenopausal woman

et al. 2021

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The prevalence of osteoporosis is about three times greater in people living with HIV than in the general population. Bisphosphonates are the only class of antiresorptive drugs which have proved to be safe and effective in HIV patients. However, bisphosphonates are not recommended in women of childbearing age due to an increased rate of associated neonatal complications. To the best of our knowledge no reports on the use of denosumab in HIV-infected individuals have been published so far. We describe a 38 year-old woman with HIV, osteoporosis and vertebral fractures treated with denosumab, a monoclonal antibody targeting RANKL. After four years of treatment, bone mineral density improved, no new fractures occurred, and neither HIV reactivation nor opportunistic infections were observed. We show that denosumab could be a safe and effective approach for osteoporosis in patients with HIV and could be considered in women of childbearing age.

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“…However, RA patients with concomitant HBV infection (both active and occult) have a high risk of hepatitis B reactivation (HBVr) when receiving bDMARDs, and administering appropriate anti‐viral prophylaxis can prevent HBVr. The risk of HBVr is highest among those with HBsAg+, followed by those with anti‐HBc+/anti‐HBs−, and anti‐HBc+/anti‐HBs+, consecutively . The risk of HBVr is high (> 10%) in rituximab, and moderate (1–10%) in anti‐TNFα and abatacept .…”

Section: Recommendationmentioning

confidence: 99%

“…The risk of HBVr is high (> 10%) in rituximab, and moderate (1–10%) in anti‐TNFα and abatacept . The use of bDMARDs does not cause HCV or HIV reactivation in patients with HCV infection or HIV‐infected patients receiving highly active anti‐retroviral therapy (HAART) . No current information exists on the use of tsDMARD in RA patients with concomitant HBV, HCV or HIV infection, as it was excluded when these infections were identified.…”

Section: Recommendationmentioning

confidence: 99%

“…As the risk of infection increases in RA patients receiving bDMARDs or tsDMARD, reactivation of latent infections, particularly tuberculosis (in those who receive mAb anti‐TNFα), HBV, HCV and HIV are of concern in endemic countries, including Thailand, where they should be properly managed . RA patients with active or latent infection should have complete physical and appropriate laboratory investigations, as well as consultation on proper management with an appropriate specialist.…”

Section: Recommendation 11mentioning

confidence: 99%

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2016 updated Thai Rheumatism Association Recommendations for the use of biologic and targeted synthetic disease‐modifying anti‐rheumatic drugs in patients with rheumatoid arthritis

et al. 2017

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Treatment considerations in patients with concomitant viral infection and autoimmune rheumatic diseases

Cited by 14 publications

References 166 publications

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

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

Denosumab for the treatment of HIV-associated osteoporosis with fractures in a premenopausal woman

2016 updated Thai Rheumatism Association Recommendations for the use of biologic and targeted synthetic disease‐modifying anti‐rheumatic drugs in patients with rheumatoid arthritis

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