Possible Reactivation of Potential Hepatitis B Virus Occult Infection by Tumor Necrosis Factor-alpha Blocker in the Treatment of Rheumatic Diseases
- Authors
- Kim, Yun Jung; Bae, Sang-Cheol; Sung, Yoon-Kyoung; Kim, Tae-Hwan; Jun, Jae-Bum; Yoo, Dae-Hyun; Kim, Tae Yeob; Sohn, Joo Hyun; Lee, Hye-Soon
- Issue Date
- Feb-2010
- Publisher
- J RHEUMATOL PUBL CO
- Keywords
- TUMOR NECROSIS FACTOR-alpha BLOCKER; HEPATITIS B VIRUS; OCCULT INFECTION; RHEUMATIC DISEASES
- Citation
- JOURNAL OF RHEUMATOLOGY, v.37, no.2, pp.346 - 350
- Indexed
- SCIE
SCOPUS
- Journal Title
- JOURNAL OF RHEUMATOLOGY
- Volume
- 37
- Number
- 2
- Start Page
- 346
- End Page
- 350
- URI
- https://scholarworks.bwise.kr/hanyang/handle/2021.sw.hanyang/175527
- DOI
- 10.3899/jrheum.090436
- ISSN
- 0315-162X
- Abstract
- Objective. To assess the safety of anti-tumor necrosis factor (TNF-alpha) therapy in patients with rheumatic diseases in terms of the reactivation of potential hepatitis B virus (HBV) occult infection. Methods. Patients who had taken anti-TNF-alpha, for the treatment of rheumatic diseases from January 2002 to May 2008 were included in the study. In this patient croup, we retrospectively investigated a series of serum aminotransferase levels. HBV serologic status. the type of anti-TNF-alpha therapy. duration of the anti-TNF-alpha, treatment, and Concurrent use of hepatotoxic drugs. Results. A total of 266 cases were documented using 3 serologic markers for HBV infection: HBV surface antigen (HBsAg). HBV surface antibody (HBsAb). and HBV core IgG Ab (HBcAb). Of these, 8 cases had chronic hepatitis B (HBsAg+). 170 cases were HBcAb-negative, and 88 cases were identified as having potential HBV occult infections represented by HBsAg-negative and HBcAb-positive irrespective of the status of the HBsAb. The frequency of clinically significant (>2 times normal value) and persistent increase (>2 consecutive tests) of aminotransferase levels was significantly higher in the group with a potential HBV occult infection compared to the HBcAb-negative group. In the Multiple logistic regression analysis controlling for various potential confounding factors such as prophylactic anti-tuberculosis medication, methotrexate. nonsteroidal antiinflammatory drugs, and the type of anti-TNF-alpha therapy, only potential HBV occult infection was a significant risk factor for abnormal liver function test (LFT). Conclusion. All rheumatic patients who plan to take anti-TNF-alpha treatment should undergo a test for serology, including HBcAb, and have a Close followup with an LFT test during. therapy. Further prospective studies for hepatitis B viral loud using HBV-polymerase chain reaction in patients who are HbcAb positive are needed to identify whether the abnormal LFT comes from the reactivation of occult HBV infection.
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