title: Discontinuation of antiviral prophylaxis correlates with high prevalence of hepatitis B virus (HBV) reactivation in rheumatoid arthritis patients with HBV carrier state: a real-world clinical practice.
abstract: BACKGROUND
  To investigate the risk of hepatitis B virus (HBV) reactivation in rheumatoid arthritis (RA) patients with HBV carrier state during treatment of disease-modifying antirheumatic drugs (DMARDs) and the use of antiviral prophylaxis in real-world clinical practice.
  
  
  METHODS
  Consecutive RA patients with HBV carrier state were included. Clinical data including liver evaluation, HBV infection evaluation and the use of antiviral prophylaxis were recorded.
  
  
  RESULTS
  Fifty-three RA patients with HBV carrier state were screened and 36 patients were qualified for analysis. Thirty-six percentage of patients developed HBV reactivation and 17% developed HBV hepatitis together with reactivation, one of which developed decompensate cirrhosis. Only 50% of patients accepted lamivudine although all patients were recommended antiviral prophylaxis with entecavir or tenofovir and only 31% continued during DMARDs therapy. Seventy-one percentage of patients who discontinued antiviral prophylaxis developed HBV reactivation 3 ~ 21 months after discontinuation. Logistic regression analyses showed discontinuation of antiviral prophylaxis (OR: 66, p = 0.027), leflunomide (OR: 64, p = 0.011) and past history of hepatitis (OR: 56, p = 0.013) were risk factors of HBV reactivation. Past history of hepatitis (OR: 10, p = 0.021) was also risk factor of HBV hepatitis together with reactivation.
  
  
  CONCLUSIONS
  Our results suggest poor patient acceptance and discontinuation of antiviral prophylaxis should not be ignored for Chinese RA patients with HBV carrier state in real-world clinical practice. Discontinuation of antiviral prophylaxis, past history of hepatitis and LEF might increase risk of HBV reactivation for RA patients with HBV carrier state during DMARDs therapy.
authors.forename: Ying-Qian
authors.initials: YQ
authors.lastname: Mo
authors.forename: An-Qi
authors.initials: AQ
authors.lastname: Liang
authors.forename: Jian-Da
authors.initials: JD
authors.lastname: Ma
authors.forename: Le-Feng
authors.initials: LF
authors.lastname: Chen
authors.forename: Dong-Hui
authors.initials: DH
authors.lastname: Zheng
authors.forename: H Ralph
authors.initials: HR
authors.lastname: Schumacher
authors.affiliation: Department of Rheumatology, Sun Yat-sen Memorial Hospital, Sun Yat-Sen University, 107# Yan Jiang West Road, Guangzhou 510120, People's Republic of China. liedai2004@163.com.
authors.forename: Lie
authors.initials: L
authors.lastname: Dai
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000453:epidemiology; D002353:Carrier State / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D006509:Hepatitis B / Q000188:drug therapy* / Q000453:epidemiology; D006515:Hepatitis B virus / Q000187:drug effects / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D056990:Post-Exposure Prophylaxis / Q000379:methods / Q000639:trends*; D015995:Prevalence; D014775:Virus Activation / Q000187:drug effects / Q000502:physiology*
chemical_list: D000998:Antiviral Agents