Outcomes of chronic hepatitis B infection in Oriental patients with rheumatic diseases.
BACKGROUND
The aim of this study was to ascertain the outcomes of chronic hepatitis B (CHB) infection following immunosuppressive therapy in 38 consecutive oriental patients with systemic rheumatic diseases.


METHODS
This is a retrospective consecutive, non-comparative study.


RESULTS
The majority of patients were female (26, 68.4%), predominantly Chinese (92.1%), with a mean age 54 +/- 14 years (range, 16 to 87). The mean duration of rheumatic disease was 9 +/- 11 years (range, 0.1 to 48), with rheumatoid arthritis (52.6%) and systemic lupus erythematosus (23.7%) being the most common. The mean duration of CHB infection was 6 +/- 5 years (range, 0.1 to 17), with the majority diagnosed during pre-methotrexate screening (50.0%) and asymptomatic transaminitis following initiation of immunosuppressive therapy (23.7%). Upon diagnosis of rheumatic disease, all patients had normal alanine aminotransferase (ALT). Of these, 18.2% were positive for hepatitis B e antigen (HBeAg) and 78.1% were positive for anti- HBe antibody. Twenty (52.6%) developed ALT elevation, which was more than twice the upper limit of normal in 12 patients. ALT normalised spontaneously in 12 patients without hepatic decompensation or change in therapy. Seven (18.4%) patients received lamivudine for 18 +/- 22 months (range, 2 to 61). Two patients developed YMDD mutation subsequently treated with adefovir (1) and adefovir/lamivudine (1). There were 3 (7.9%) hepatitis B virus (HBV)-unrelated deaths [infection (2), genitourinary malignancy (1)], and 1 from HBV-reactivation complicated by septicaemia. None have developed hepatocellular carcinoma.


CONCLUSIONS
Elevated ALT occurred in 52.6% of patients, with only 18.4% requiring anti-viral therapy for HBV reactivation. HBV-related mortality was low. With the appropriate precautionary measures, prednisolone and immunosuppressants (except methotrexate and leflunomide) may be used safely in patients where clinically indicated.
Thong
Bernard Y H
BY
Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore. bernard_thong@ttsh.com.sg
Koh
Ee Tzun
ET
Chng
Hiok Hee
HH
Chow
Wan Cheng
WC
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000410:Alanine Transaminase / Q000097:blood; D000998:Antiviral Agents / Q000627:therapeutic use; D044466:Asian People; D015897:Comorbidity; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D019694:Hepatitis B, Chronic / Q000453:epidemiology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D019259:Lamivudine / Q000627:therapeutic use; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D011239:Prednisolone / Q000627:therapeutic use; D012189:Retrospective Studies; D012216:Rheumatic Diseases / Q000453:epidemiology*; D016896:Treatment Outcome; D014775:Virus Activation
D000998:Antiviral Agents; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D019259:Lamivudine; D011239:Prednisolone; D000410:Alanine Transaminase