[Investigation of the risk of hepatitis B virus reactivation in arthritis patients undergoing anti-tumour necrosis factor alpha therapy].
OBJECTIVE
To investigate the prevalence of HBV infection and the risk of hepatitis B virus (HBV) reactivation in patients with inflammatory arthritis receiving tumour hecrosis factor alpha (TNFα) inhibitors.


METHODS
The liver function, serology of HBV and viral loads (HBV DNA) were tested before using TNFα inhibitors, at 3 months and 6 months. Patients with chronic hepatitis B (CHB) infection (HBV DNA > 1×10(3) copies/ml) were eliminated.


RESULTS
A total of 162 patients were investigated including 156 patients who finished the study. Eleven (7.05%) patients were HBsAg-positive. Two patients with HBV DNA > 1×10(3) copies/ml were eliminated before starting anti-TNFα therapy. Among HBsAg-positive patients, HBV reactivation was documented in only one of the 11 patients. This patient with rheumatoid arthritis developed elevation of glutamic-pyruvic transaminase (ALT) and HBV DNA copies three months after infliximab therapy. Therefore lamivudine was given for three months, which translated into the fall of ALT and HBV DNA copies back to normal level. After follow-up for six months, the virology and serology remained stable. In contrast, none of the other 155 patients had demonstrated evidence of HBV infection or HBV reactivation.


CONCLUSIONS
The kinetics of HBV viral loads should be carefully monitored in patients with inflammatory arthritis and HBsAg-positive during anti-TNFα therapy. HBV reactivation should be treated with antiviral medicine through out the period of anti-TNFα therapy.
Dier
D
Jin
Ning
N
Tie
Jing
J
Liu
Lei
L
Zhao
Donglin
D
Hao
Department of Immunology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100032, China; Email: zhaoyan_pumch 2002@aliyun.com.
Yan
Y
Zhao
D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D000998:Antiviral Agents; D001168:Arthritis; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000188:drug therapy / Q000821:virology*; D006509:Hepatitis B / Q000150:complications / Q000453:epidemiology / Q000821:virology*; D006514:Hepatitis B Surface Antigens; D006515:Hepatitis B virus / Q000378:metabolism*; D019694:Hepatitis B, Chronic; D006801:Humans; D000069285:Infliximab; D015995:Prevalence; D014409:Tumor Necrosis Factor-alpha / Q000008:administration & dosage* / Q000037:antagonists & inhibitors; D019562:Viral Load; D014775:Virus Activation
D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D000998:Antiviral Agents; D006514:Hepatitis B Surface Antigens; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab