title: Current antiviral practice and course of Hepatitis B virus infection in inflammatory arthritis: a multicentric observational study (A + HBV study).
abstract: OBJECTIVE
  The reactivation of hepatitis B virus (HBV) infection is a well-known event in hepatitis B surface antigen (HbsAg)-positive patients receiving immunosuppressive therapy. The objective of this study was to assess the antiviral practice and course of HBV infection in inflammatory arthritis.
  
  
  METHODS
  Nineteen rheumatology centers participated in this retrospective study. HbsAg-positive patients who were taking disease-modifying antirheumatic drugs and who were being tested for HBV viral load at a minimum of two different time points were included. The case report form (CRF) consisted of demographic data, rheumatic diseases, treatment profiles, transaminase levels, viral hepatitis serological markers, and HBV viral load. The reactivation of HBV was defined as the abrupt rise in HBV replication by an increase in serum HBV DNA levels in a patient with a previously inactive HBV infection.
  
  
  RESULTS
  In total, the data of 101 (female 50.5%) patients were included (76 patients with inactive HBV carriers and 25 patients with chronic HBV infection). The mean age of patients was 44±12 years, and the mean follow-up duration was 31±22 months. Of the 101 patients, 70 (69.3%) received antiviral treatment. HBV reactivation was detected in 13 of 76 (17.1%) patients with inactive HBV carriers. HBV reactivation was observed less frequently, not although significantly, in those patients receiving antiviral prophylaxis compared with those not receiving prophylaxis [5/41 (12.2%) vs. 8/33 (24.2%), p=0.17]. Forty-two patients (31 patients had inactive HBV carriers) were using anti-tumor necrosis factor agents. HBV reactivation was detected in 6 of the 31 (19.3%) patients. Twenty-five patients had chronic hepatitis, and five (20%) of them had not received antiviral prophylaxis. HBV viral loads were persistently elevated in 7 (28%) of 25 patients (three patients under and four patients not under antiviral treatment).
  
  
  CONCLUSIONS
  HBV reactivation was observed in approximately 17% of patients under immunosuppressive treatments. HBV reactivation was more frequently observed in those who did not receive antiviral prophylaxis.
authors.affiliation: Department of Internal Medicine, Division of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
authors.forename: Umut
authors.initials: U
authors.lastname: Kalyoncu
authors.affiliation: Department of Internal Medicine, Division of Rheumatology, Ege University Faculty of Medicine, İzmir, Turkey.
authors.forename: Hakan
authors.initials: H
authors.lastname: Emmungil
authors.affiliation: Department of Internal Medicine, Division of Rheumatology, Gaziantep University Faculty of Medicine, Gaziantep, Turkey.
authors.forename: Ahmet Mesut
authors.initials: AM
authors.lastname: Onat
authors.affiliation: Division of Rheumatology, Gülhane Military Faculty of Medicine, Ankara, Turkey.
authors.forename: Sedat
authors.initials: S
authors.lastname: Yılmaz
authors.affiliation: Department of Internal Medicine, Division of Rheumatology, Osmangazi University, Faculty of Medicine, Eskişehir, Turkey.
authors.forename: Timuçin
authors.initials: T
authors.lastname: Kaşifoglu
authors.affiliation: Department of Internal Medicine, Division of Rheumatology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey.
authors.forename: Servet
authors.initials: S
authors.lastname: Akar
authors.affiliation: Department of Internal Medicine, Division of Rheumatology, Marmara University Faculty of Medicine, İstanbul, Turkey.
authors.forename: Nevsun
authors.initials: N
authors.lastname: İnanç
authors.affiliation: Department of Internal Medicine, Division of Rheumatology, Çukurova University Faculty of Medicine, Adana, Turkey.
authors.forename: Fatih
authors.initials: F
authors.lastname: Yıldız
authors.affiliation: Department of Internal Medicine, Division of Rheumatology, Ankara University Faculty of Medicine, Ankara, Turkey.
authors.forename: Orhan
authors.initials: O
authors.lastname: Küçükşahin
authors.affiliation: Division of Rheumatology, Diyarbakır Goverment Hospital, Diyarbakır, Turkey.
authors.forename: Ömer
authors.initials: Ö
authors.lastname: Karadağ
authors.affiliation: Department of Internal Medicine, Division of Rheumatology, Gazi University Faculty of Medicine, Ankara, Turkey.
authors.forename: Rıdvan
authors.initials: R
authors.lastname: Mercan
authors.affiliation: Department of Internal Medicine, Division of Rheumatology, Abant Izzet Baysal University Faculty of Medicine, Bolu, Turkey.
authors.forename: Cemal
authors.initials: C
authors.lastname: Bes
authors.affiliation: Department of Internal Medicine, Division of Rheumatology, Antalya University Faculty of Medicine, Antalya, Turkey.
authors.forename: Veli
authors.initials: V
authors.lastname: Yazısız
authors.affiliation: Department of Internal Medicine, Division of Rheumatology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey.
authors.forename: Barış
authors.initials: B
authors.lastname: Yılmazer
authors.affiliation: Department of Internal Medicine, Division of Rheumatology, İzmir Atatürk Training and Research Hospital, İzmir, Turkey.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Özmen
authors.affiliation: Department of Internal Medicine, Division of Rheumatology, Ankara Atatürk Education and Research Hospital, Ankara, Turkey.
authors.forename: Şükran
authors.initials: Ş
authors.lastname: Erten
authors.affiliation: Department of Internal Medicine, Division of Rheumatology, Erciyes University Faculty of Medicine, Kayseri, Turkey.
authors.forename: Soner
authors.initials: S
authors.lastname: Şenel
authors.affiliation: Department of Internal Medicine, Division of Rheumatology, Sakarya Education and Research Hospital, Sakarya, Turkey.
authors.forename: Ayten
authors.initials: A
authors.lastname: Yazıcı
authors.affiliation: Department of Internal Medicine, Division of Rheumatology, Cerrahpaşa University, Faculty of Medicine, İstanbul, Turkey.
authors.forename: Koray
authors.initials: K
authors.lastname: Taşçılar
authors.affiliation: Department of Internal Medicine, Division of Rheumatology, Ege University Faculty of Medicine, İzmir, Turkey.
authors.forename: Melike
authors.initials: M
authors.lastname: Kalfa
authors.affiliation: Department of Internal Medicine, Division of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
authors.forename: Sedat
authors.initials: S
authors.lastname: Kiraz
authors.affiliation: Department of Internal Medicine, Division of Rheumatology, Gaziantep University Faculty of Medicine, Gaziantep, Turkey.
authors.forename: Bünyamin
authors.initials: B
authors.lastname: Kısacık
authors.affiliation: Department of Internal Medicine, Division of Rheumatology, Gaziantep University Faculty of Medicine, Gaziantep, Turkey.
authors.forename: Yavuz
authors.initials: Y
authors.lastname: Pehlivan
authors.affiliation: Department of Internal Medicine, Division of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
authors.forename: Levent
authors.initials: L
authors.lastname: Kılıç
authors.affiliation: Division of Rheumatology, Gülhane Military Faculty of Medicine, Ankara, Turkey.
authors.forename: İsmail
authors.initials: İ
authors.lastname: Şimşek
authors.affiliation: Department of Internal Medicine, Division of Rheumatology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey.
authors.forename: Ayşe
authors.initials: A
authors.lastname: Çefle
authors.affiliation: Department of Internal Medicine, Division of Rheumatology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey.
authors.forename: Nurullah
authors.initials: N
authors.lastname: Akkoç
authors.affiliation: Department of Internal Medicine, Division of Rheumatology, Marmara University Faculty of Medicine, İstanbul, Turkey.
authors.forename: Haner
authors.initials: H
authors.lastname: Direskeneli
authors.affiliation: Department of Internal Medicine, Division of Rheumatology, Çukurova University Faculty of Medicine, Adana, Turkey.
authors.forename: Eren
authors.initials: E
authors.lastname: Erken
authors.affiliation: Department of Internal Medicine, Division of Rheumatology, Ankara University Faculty of Medicine, Ankara, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Turgay
authors.affiliation: Department of Internal Medicine, Division of Rheumatology, Gazi University Faculty of Medicine, Ankara, Turkey.
authors.forename: Mehmet Akif
authors.initials: MA
authors.lastname: Öztürk
authors.affiliation: Department of Internal Medicine, Division of Rheumatology, Abant Izzet Baysal University Faculty of Medicine, Bolu, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Soy
authors.affiliation: Department of Internal Medicine, Division of Rheumatology, Ege University Faculty of Medicine, İzmir, Turkey.
authors.forename: Kenan
authors.initials: K
authors.lastname: Aksu
authors.affiliation: Division of Rheumatology, Gülhane Military Faculty of Medicine, Ankara, Turkey.
authors.forename: Ayhan
authors.initials: A
authors.lastname: Dinç
authors.affiliation: Department of Internal Medicine, Division of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
authors.forename: İhsan
authors.initials: İ
authors.lastname: Ertenli
keywords: Rheumatoid arthritis; ankylosing spondylitis; hepatitis B infection; hepatitis B reactivation; hepatitis B viral load