류마티스 질환에서 항 TNF-α 치료가만성 HBV 감염의 경과에 미치는 영향

Abstract

Objective: To assess the safety of anti-tumor necrosis factor (TNF)-α therapy in patients with rheumatic disease and chronic Hepatitis B virus (HBV) infection. Methods: We used infliximab or etanercept therapy in patients with rheumatic disease and chronic HBV infection. Records concerning these patients were retrospectively reviewed for the duration of disease, treatment, serological status and biological data. Results: Six relevant cases with chronic HBV infection were identified: three of RA; three of AS. Four patients had received etanercept; two had been given etanercept after infliximab. One of the cases treated with lamivudine before anti-TNF-α therapy for chronic hepatitis B treatment. His hepatitis status was maintained stable after he initiated anti-TNF-α therapy. Five of the cases started anti-TNF-α therapy without lamivudine. Two of these five cases were received lamivudine during anti-TNF-α therapy due to elevation of HBV DNA titer without liver function test abnormality and then HBV DNA was normalized. Three cases without lamivudine continued to show the stable level of liver enzyme but, one of the three cases showed persistently elevated HBV DNA titer. Conclusion: Prophylactic or early intervention strategies with anti-viral agent and regular monitoring of aminotransferases and viral load are needed for patient with evidence of chronic HBV infection.