PT  - JOURNAL ARTICLE
AU  - SOO-JIN CHUNG
AU  - JA KYUNG KIM
AU  - MIN-CHAN PARK
AU  - YONG-BEOM PARK
AU  - SOO-KON LEE
TI  - Reactivation of Hepatitis B Viral Infection in Inactive HBsAg Carriers Following Anti-Tumor Necrosis Factor-α Therapy
AID  - 10.3899/jrheum.081324
DP  - 2009 Nov 01
TA  - The Journal of Rheumatology
PG  - 2416--2420
VI  - 36
IP  - 11
4099  - http://www.jrheum.org/content/36/11/2416.short
4100  - http://www.jrheum.org/content/36/11/2416.full
SO  - J Rheumatol2009 Nov 01; 36
AB  - Objective. To investigate whether anti-tumor necrosis factor-α (TNF-α) therapy can influence the reactivation of hepatitis B virus (HBV) infection in inactive HBsAg carriers. Methods. The medical records of 103 patients [59 with ankylosing spondylitis (AS), 41 with rheumatoid arthritis (RA), 2 with juvenile RA, and 1 with psoriatic arthritis] who had been treated with anti-TNF-α therapy were reviewed retrospectively. Data on seropositivity of HBV, HBV load, and serum aminotransferases prior to and after initiation of anti-TNF-α therapy were obtained. Results. Eight patients were inactive HBsAg carriers, and all of them had normal liver function and undetectable HBV load prior to anti-TNF-α therapy. Reactivation of hepatitis B occurred in 1 patient during the course of anti-TNF-α therapy. After the third infusion of infliximab 5 mg/kg at Week 6, a blood test showed that the patient had normal liver function. When the patient returned for the fourth infusion of infliximab at Week 14, a blood test showed markedly elevated aspartate aminotransferase (AST)/alanine aminotransferase (ALT) levels (457 and 1054 IU/l, respectively) and increased viral DNA by HBV polymerase chain reaction (PCR). The fourth infliximab infusion was canceled, and entecavir 0.5 mg/day was prescribed. Then AST/ALT levels began to decrease and returned to normal range after 3 months. Followup HBV PCR showed negative results. Conclusion. We found 1 HBV reactivation case among 8 inactive HBsAg carriers following anti-TNF-α therapy. This finding supports the prophylactic use of antiviral agents in HBV carriers, even if they have normal liver function or an undetectable viral load.