Hepatitis B virus reactivation by immunosuppressive therapy in patients with autoimmune diseases: risk analysis in Hepatitis B surface antigen-negative cases.

Abstract

OBJECTIVE:

To evaluate the risk of reactivation of resolved hepatitis B virus (HBV) by immunosuppressive therapy in patients with autoimmune diseases.

METHODS:

Thirty-five patients with autoimmune diseases were included in our study; all were hepatitis B surface antigen (HBsAg)-negative and antibody against hepatitis B core antigen-positive. They were followed for 8-124 weeks and clinical outcomes were analyzed, including serum levels of HBV-DNA and aminotransferase every 4 weeks during their immunosuppressive therapy for underlying autoimmune diseases. If HBV-DNA was detected during the immunosuppressive therapy, HBsAg, antibody against HBsAg (anti-HBs), hepatitis B e antigen (HBeAg), and antibody against HBeAg were also monitored every 4 weeks.

RESULTS:

HBV-DNA was detected in 6 out of 35 patients. Anti-HBs titer was significantly lower in the patients in whom HBV-DNA was detected compared with the others at baseline: 2.83 (range 0.24-168.50) mIU/ml vs 99.94 (range 0.00-5342.98) mIU/ml, respectively (p = 0.036). Outcomes of the 6 patients with HBV reactivation were as follows: HBV-DNA turned negative in 2 patients without nucleic acid analog (NAA) and 1 with NAA; 2 died due to bacterial sepsis; and 1 died due to autoimmune hemolytic anemia. Significant elevation of aminotransferase was found in only 1 patient, but HBsAg converted to positive in 2 patients and HBeAg converted to positive in 1 patient.

CONCLUSION:

Reactivation of resolved HBV can occur during standard immunosuppressive therapy for autoimmune diseases. The low titer of baseline anti-HBs may carry its risk.

• Authors: Masaru Kato, Tatsuya Atsumi, Takashi Kurita, Toshio Odani, Yuichiro Fujieda, Kotaro Otomo, Tetsuya Horita, Shinsuke Yasuda, Takao Koike
• Journal: The Journal of rheumatology (J Rheumatol) Vol. 38 Issue 10 Pg. 2209-14 (Oct 2011) ISSN: 0315-162X [Print] Canada
• PMID: 21844146 (Publication Type: Journal Article)

Chemical References

• DNA, Viral
• Hepatitis B Core Antigens
• Hepatitis B Surface Antigens
• Immunosuppressive Agents

Topics

• Adult
• Aged
• Aged, 80 and over
• Autoimmune Diseases (drug therapy)
• DNA, Viral (immunology)
• Female
• Hepatitis B Core Antigens (immunology)
• Hepatitis B Surface Antigens (immunology)
• Hepatitis B virus (physiology)
• Humans
• Immunosuppressive Agents (adverse effects, therapeutic use)
• Male
• Middle Aged
• Risk Assessment
• Virus Activation (drug effects, immunology)