RT Journal Article
SR Electronic
T1 Reactivation of Hepatitis B Viral Infection in Inactive HBsAG Carriers Following Anti-Tumor Necrosis Factor-α Therapy
JF The Journal of Rheumatology
JO J Rheumatol
FD The Journal of Rheumatology
SP jrheum.081324
DO 10.3899/jrheum.081324
A1 Soo-Jin Chung
A1 Ja Kyung Kim
A1 Min-Chan Park
A1 Yong-Beom Park
A1 Soo-Kon Lee
YR 2009
UL http://www.jrheum.org/content/early/2009/09/30/jrheum.081324.abstract
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.