title: No detection of occult HBV-DNA in patients with various rheumatic diseases treated with anti-TNF agents: a two-year prospective study.
abstract: OBJECTIVE
  The widespread use of tumour necrosis factor (TNF)-targeted therapies in patients with rheumatic, digestive and dermatologic diseases has been associated with reports of reactivation of HBV replication and ensuing hepatitis flares both in asymptomatic HBsAg carriers and in subjects with occult HBV infection. The aim of our work was to investigate in a two-year prospective study the potential for HBV reactivation in patients with inflammatory joint diseases undergoing anti-TNF treatment from a southern Mediterranean area.
  
  
  METHODS
  Fifty-seven consecutive outpatients attending the Academic Unit of Rheumatology at the University of Palermo (12 with rheumatoid arthritis, 17 with psoriatic arthritis and 28 with ankylosing spondylitis) were enrolled in the study. HBV-DNA was tested by a standard quantitative assay in HBsAg-positive subjects and by an ad hoc highly sensitive PCR in HBsAg-negative patients performed at baseline and then every six months on the anti-TNF agent.
  
  
  RESULTS
  Occult HBV-DNA was never detected in the 54 HBsAg negative subjects, regardless of their anti HBs/HBc status. All HBsAg positive patients, who were started on prophylactic lamivudine, remained HBV-DNA undetectable throughout the anti-TNF treatment.
  
  
  CONCLUSIONS
  Even in an area of previously high HBV endemicity, where occult HBV infection is likely to have a high prevalence, treatment of rheumatological patients with anti-TNF drugs is safe in terms of its potential to reactivate HBV. Prophylaxis with lamivudine is sufficient to prevent reactivation in HBsAg carriers.
authors.affiliation: Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, Palermo, Italy. a.ritagiardina@libero.it
authors.forename: Anna Rita
authors.initials: AR
authors.lastname: Giardina
authors.forename: Donatella
authors.initials: D
authors.lastname: Ferraro
authors.forename: Francesco
authors.initials: F
authors.lastname: Ciccia
authors.forename: Angelo
authors.initials: A
authors.lastname: Ferrante
authors.forename: Rosa
authors.initials: R
authors.lastname: Di Stefano
authors.forename: Antonio
authors.initials: A
authors.lastname: Craxì
authors.forename: Giovanni
authors.initials: G
authors.lastname: Triolo
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000998:Antiviral Agents / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D004279:DNA, Viral / Q000097:blood*; D005260:Female; D006509:Hepatitis B / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006515:Hepatitis B virus / Q000187:drug effects / Q000235:genetics* / Q000276:immunology; D006801:Humans; D007558:Italy / Q000453:epidemiology; D019259:Lamivudine / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D011446:Prospective Studies; D012216:Rheumatic Diseases / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000276:immunology; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D014775:Virus Activation
chemical_list: D018501:Antirheumatic Agents; D000998:Antiviral Agents; D015415:Biomarkers; D004279:DNA, Viral; D006514:Hepatitis B Surface Antigens; D014409:Tumor Necrosis Factor-alpha; D019259:Lamivudine