title: Kinetic profiles and management of hepatitis B virus reactivation in patients with immune-mediated inflammatory diseases.
abstract: OBJECTIVE
  Immunosuppressive therapy may trigger hepatitis B virus (HBV) reactivation for increased morbidity and mortality. We aimed to describe HBV reactivation in patients receiving treatment for immune-mediated inflammatory diseases (IMIDs) and to evaluate a predefined algorithm for its prevention.
  
  
  METHODS
  Physicians submitted data for patients receiving treatment for IMIDs and exhibiting HBV reactivation, defined as an increase of >1 log10 IU/ml of HBV DNA levels or DNA reappearance. We systematically reviewed cases in the literature.
  
  
  RESULTS
  The 35 physician-collected patients had rheumatoid arthritis (n = 14), connective tissue disease (n = 7), vasculitis (n = 5), and other diseases (n = 9). At baseline, 65.7% of patients were positive for hepatitis B surface antigen (HBsAg), 31.4% had a history of HBV infection, and 2.9% had occult HBV infection. Reactivation occurred a median of 35 weeks (range 2-397 weeks) after the start of corticosteroid and/or immunosuppressive therapy. In all, 88.6% of patients were clinically asymptomatic, but 25.7% had severe hepatitis; none had fulminant hepatitis. Management was antiviral therapy for 91.4%, with discontinuation or decrease of immunosuppressive therapy for 45.7%. In pooling these 35 cases and 103 patients from the literature, 73.9% of patients were clinically asymptomatic, 33.3% had severe hepatitis, and 12.3% died and/or had fulminant hepatitis. Reactivation occurred early with rituximab or cyclophosphamide therapy and in HBsAg-positive/HBV DNA-positive patients. Using the predefined algorithm, 78% of patients with reactivation would have received preemptive antiviral therapy.
  
  
  CONCLUSIONS
  We provide new insights into HBV reactivation in patients receiving treatment for IMIDs. A predefined algorithm may be effective in reducing the risk of HBV reactivation in this population.
authors: Université Paris Descartes, AP-HP, Hôpital Cochin, Paris, France.
authors: Nina
authors: N
authors: Droz
authors: Laurent
authors: L
authors: Gilardin
authors: Patrice
authors: P
authors: Cacoub
authors: Francis
authors: F
authors: Berenbaum
authors: Daniel
authors: D
authors: Wendling
authors: Bertrand
authors: B
authors: Godeau
authors: Anne-Marie
authors: AM
authors: Piette
authors: Emmanuelle
authors: E
authors: Dernis
authors: Mikael
authors: M
authors: Ebbo
authors: Bruno
authors: B
authors: Fautrel
authors: Guillaume
authors: G
authors: Le Guenno
authors: Arsène
authors: A
authors: Mekinian
authors: Brigitte
authors: B
authors: Bernard-Chabert
authors: Nathalie
authors: N
authors: Costedoat-Chalumeau
authors: Elodie
authors: E
authors: Descloux
authors: Jean-Marie
authors: JM
authors: Michot
authors: Sylvie
authors: S
authors: Radenne
authors: Aude
authors: A
authors: Rigolet
authors: Sophie
authors: S
authors: Rivière
authors: Jean-Luc
authors: JL
authors: Yvin
authors: Vincent
authors: V
authors: Thibault
authors: Dominique
authors: D
authors: Thabut
authors: Stanislas
authors: S
authors: Pol
authors: Loïc
authors: L
authors: Guillevin
authors: Luc
authors: L
authors: Mouthon
authors: Benjamin
authors: B
authors: Terrier
mesh_terms: D000328:Adult; D000368:Aged; D019468:Disease Management; D005260:Female; D006509:Hepatitis B / Q000188:drug therapy* / Q000453:epidemiology / Q000276:immunology*; D006515:Hepatitis B virus / Q000276:immunology* / Q000378:metabolism; D006801:Humans; D007154:Immune System Diseases / Q000139:chemically induced / Q000473:pathology* / Q000821:virology; D007165:Immunosuppression Therapy / Q000009:adverse effects / Q000379:methods; D007249:Inflammation / Q000139:chemically induced / Q000276:immunology / Q000821:virology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014775:Virus Activation / Q000276:immunology