title: Hepatitis B virus (HBV) reactivation in rheumatic patients with hepatitis core antigen (HBV occult carriers) undergoing anti-tumor necrosis factor therapy.
abstract: OBJECTIVE
  The aim of this study was to assess the effects of anti-tumour necrosis factor (TNF) agents on hepatitis B virus (HBV) reactivation in hepatitis B surface antigen (HBsAg)-negative and anti-hepatitis B core (HBc)-positive patients (HBV occult carriers) with rheumatic diseases.
  
  
  METHODS
  Evidence of HBV reactivation after anti-TNF therapy in HBV occult carriers with a rheumatic disease was studied by summarising results and by performing meta-analysis analysis.
  
  
  RESULTS
  A total of 468 HBsAg-negative and anti-HBc-positive patients with a rheumatic disease undergoing treatment with an anti-TNF agent were identified in nine studies. The anti-TNF agents used were etanercept in 269 cases, adalimumab in 95, and infliximab in 100 cases, and these were administered for rheumatoid arthritis (RA) in 327 patients, ankylosing spondylitis in 49, and psoriatic arthritis (PsA) in 73 patients. Follow-up periods ranged from 6 to 60 months. HBV reactivation in patients on an anti-TNF agent was reported in 8 cases (8/468 = 1.7%). Seven of these patients had RA and 1 had PsA. Seven patients received etanercept and one adalimumab. HBV-DNA was detectable in 7 of these 8 cases. Antiviral treatment was administered in 6 of the 8 (lamivudine in 2, entecavir in 4) and clinical outcomes were satisfactory in all 8 patients.
  
  
  CONCLUSIONS
  HBV reactivation was found in 8 (1.7%) patients among 468 HBsAg-negative and anti-HBc-positive patients with rheumatic diseases treated with anti-TNF agents. Our data suggest that HBsAg-negative and anti-HBc-positive patients undergoing anti-TNF therapy need to be carefully monitored during anti-TNF therapy.
authors.affiliation: Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea. lyhcgh@korea.ac.kr
authors.forename: Young Ho
authors.initials: YH
authors.lastname: Lee
authors.forename: Sang-Cheol
authors.initials: SC
authors.lastname: Bae
authors.forename: Gwan Gyu
authors.initials: GG
authors.lastname: Song
mesh_terms: D018501:Antirheumatic Agents / Q000009:adverse effects*; D000998:Antiviral Agents / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D004279:DNA, Viral / Q000097:blood; D006509:Hepatitis B / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology; D006512:Hepatitis B Core Antigens / Q000097:blood*; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006515:Hepatitis B virus / Q000187:drug effects* / Q000235:genetics / Q000276:immunology; D006801:Humans; D012216:Rheumatic Diseases / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D014775:Virus Activation / Q000187:drug effects*
chemical_list: D018501:Antirheumatic Agents; D000998:Antiviral Agents; D015415:Biomarkers; D004279:DNA, Viral; D006512:Hepatitis B Core Antigens; D006514:Hepatitis B Surface Antigens; D014409:Tumor Necrosis Factor-alpha