title: Incidence and clinical characteristics of hepatitis B virus reactivation in HBsAg-negative/HBcAb-positive patients receiving rituximab for rheumatoid arthritis.
abstract: OBJECTIVE
  To analyse the incidence, clinical characteristics, and prognosis of patients with rheumatoid arthritis (RA) and hepatitis B virus (HBV) surface antigen negative/core antibody positive serostatus (HBsAg-/HBcAb+), who underwent rituximab therapy and developed HBV reactivation.
  
  
  METHODS
  Medical records of RA patients with different HBV serostatus who received rituximab from January 2000 through January 2015 were reviewed. Case notes of four HBsAg-/HBcAb+ patients with RA who had HBV reactivation during treatment with rituximab were excerpted and summarised. We also searched the Medline (PubMed) database to identify published reports of other HBsAg-/HBcAb+ RA patients who likewise developed HBV reactivation during rituximab treatment.
  
  
  RESULTS
  The study cohort comprised 54 RA patients who received rituximab, of whom 44 (81.5%) were HBsAg-/HBcAb+ whilst receiving rituximab. Four HBsAg-/HBcAb+ patients had HBV reactivations during rituximab therapy; thus, the incidence of HBV reactivation in the HBsAg-/HBcAb+ group was 9.1%. The literature search discovered another three cases, making a total of at least seven known rituximab-treated HBsAg-/HBcAb+ RA patients who have developed HBV reactivation. The mean duration from the first rituximab infusion to HBV reactivation was 25.4±4.6 months; no fatalities occurred.
  
  
  CONCLUSIONS
  Approximately 9% of Taiwanese RA patients with HBsAg-/HBcAb+ serostatus had HBV reactivation around 2 years after starting regular rituximab therapy; they all had a relatively good prognosis.
authors.affiliation: Allergy, Immunology and Rheumatology Division, Department of Internal Medicine, Changhua Christian Hospital, Changhua City, Taiwan.
authors.forename: Ya-Chih
authors.initials: YC
authors.lastname: Tien
authors.affiliation: Gastroenterology Division, Department of Internal Medicine, Changhua Christian Hospital, Changhua City; and General Education Center, Chienkuo Technology University, Changhua City, Taiwan.
authors.forename: Hsu-Heng
authors.initials: HH
authors.lastname: Yen
authors.affiliation: Allergy, Immunology and Rheumatology Division, Department of Internal Medicine, Changhua Christian Hospital, Changhua City; and Department of Nursing, College of Medicine and Nursing, Hung Kuang University, Taichung City, Taiwan. 129273@cch.org.tw.
authors.forename: Ying-Ming
authors.initials: YM
authors.lastname: Chiu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000998:Antiviral Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D015415:Biomarkers / Q000097:blood; D005260:Female; D016174:Hepacivirus / Q000187:drug effects / Q000276:immunology / Q000472:pathogenicity*; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006526:Hepatitis C / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology / Q000821:virology; D018937:Hepatitis C Antibodies / Q000097:blood; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D015994:Incidence; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D000069283:Rituximab / Q000009:adverse effects*; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome; D014775:Virus Activation / Q000187:drug effects
chemical_list: D000998:Antiviral Agents; D015415:Biomarkers; D006514:Hepatitis B Surface Antigens; D018937:Hepatitis C Antibodies; D007166:Immunosuppressive Agents; D000069283:Rituximab