Possible reactivation of potential hepatitis B virus occult infection by tumor necrosis factor-alpha blocker in the treatment of rheumatic diseases.

Abstract

OBJECTIVE:

To assess the safety of anti-tumor necrosis factor (TNF-alpha) therapy in patients with rheumatic diseases in terms of the reactivation of potential hepatitis B virus (HBV) occult infection.

METHODS:

Patients who had taken anti-TNF-alpha for the treatment of rheumatic diseases from January 2002 to May 2008 were included in the study. In this patient group, we retrospectively investigated a series of serum aminotransferase levels, HBV serologic status, the type of anti-TNF-alpha therapy, duration of the anti-TNF-alpha treatment, and concurrent use of hepatotoxic drugs.

RESULTS:

A total of 266 cases were documented using 3 serologic markers for HBV infection: HBV surface antigen (HBsAg), HBV surface antibody (HBsAb), and HBV core IgG Ab (HBcAb). Of these, 8 cases had chronic hepatitis B (HBsAg+), 170 cases were HBcAb-negative, and 88 cases were identified as having potential HBV occult infections represented by HBsAg-negative and HBcAb-positive, irrespective of the status of the HBsAb. The frequency of clinically significant (> 2 times normal value) and persistent increase (> 2 consecutive tests) of aminotransferase levels was significantly higher in the group with a potential HBV occult infection compared to the HBcAb-negative group. In the multiple logistic regression analysis controlling for various potential confounding factors such as prophylactic anti-tuberculosis medication, methotrexate, nonsteroidal antiinflammatory drugs, and the type of anti-TNF-alpha therapy, only potential HBV occult infection was a significant risk factor for abnormal liver function test (LFT).

CONCLUSION:

All rheumatic patients who plan to take anti-TNF-alpha treatment should undergo a test for HBV serology, including HBcAb, and have a close followup with an LFT test during therapy. Further prospective studies for hepatitis B viral load using HBV-polymerase chain reaction in patients who are HbcAb positive are needed to identify whether the abnormal LFT comes from the reactivation of occult HBV infection.

• Authors: Yun Jung Kim, Sang-Cheol Bae, Yoon-Kyoung Sung, Tae-Hwan Kim, Jae-Bum Jun, Dae-Hyun Yoo, Tae Yeob Kim, Joo Hyun Sohn, Hye-Soon Lee
• Journal: The Journal of rheumatology (J Rheumatol) Vol. 37 Issue 2 Pg. 346-50 (Feb 2010) ISSN: 0315-162X [Print] Canada
• PMID: 20008922 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antibodies, Monoclonal
• Antibodies, Monoclonal, Humanized
• Immunoglobulin G
• Receptors, Tumor Necrosis Factor
• Infliximab
• Adalimumab
• Etanercept

Topics

• Adalimumab
• Adult
• Aged
• Antibodies, Monoclonal (therapeutic use)
• Antibodies, Monoclonal, Humanized
• Disease Susceptibility (immunology)
• Etanercept
• Female
• Hepatitis B (immunology)
• Hepatitis B virus (immunology)
• Humans
• Immunoglobulin G (therapeutic use)
• Infliximab
• Male
• Middle Aged
• Receptors, Tumor Necrosis Factor (antagonists & inhibitors, immunology, therapeutic use)
• Regression Analysis
• Retrospective Studies
• Rheumatic Diseases (immunology, therapy)