TY - JOUR T1 - Reactivation of Hepatitis B Virus After Steroid Treatment in Rheumatic Diseases JF - The Journal of Rheumatology JO - J Rheumatol SP - 181 LP - 182 DO - 10.3899/jrheum.100692 VL - 38 IS - 1 AU - JUN CHENG AU - JIA-BIN LI AU - QIU-LIN SUN AU - XU LI Y1 - 2011/01/01 UR - http://www.jrheum.org/content/38/1/181.abstract N2 - To the Editor:Hepatitis B virus (HBV) infection is a global problem and is particularly endemic in some regions of the world. More than one-third of the world’s population has been infected with the HBV and there are 350 million people with chronic infection; 75% of them live in Southeast Asia and the Western Pacific regions1,2. There is a chance of reactivation of a previous HBV infection in patients undergoing chemotherapy or immunosuppressive therapy for rheumatism, malignancies, autoimmune hepatitis, and systemic lupus erythematosus (SLE); this reactivation is a major cause of morbidity and mortality3. Reactivation of HBV was first described by Wands, et al, who in 1975 reported the condition in 20 patients with lymphoproliferative and myeloproliferative disorders4,5. Induced immunosuppression allows a rapid increase in viral replications and antigen expression. Restoration of immune function causes rapid, T cell–mediated destruction of HBV-infected hepatocytes that manifests clinically as asymptomatic self-limiting anicteric hepatitis to severe hepatitis, potentially fatal progressive decompensated hepatitis, and even death6.In routine clinical practice, it is common to come across patients with rheumatic diseases who have HBsAg-positive serology (“overt” carriers). It is estimated that 21%–67% are affected (mean 50%), with a mean mortality rate of 20%6,7,8. However, clinical events can also develop in “occult” carriers, i.e., patients who are HBsAg-negative but positive for other markers of prior exposure to the virus, including HBcAb alone or in combination with HBsAb. Further, about 12% of anti-core-positive subjects (HBsAg-negative) experience reemergence of HBsAg (seroreversion)6,9. Several risk factors have … Address correspondence to Dr. J-B. Li; E-mail: lijiabin948{at}vip.sohu.com ER -