Hepatitis B virus reactivation by immunosuppressive therapy in patients with autoimmune diseases

Risk analysis in hepatitis B surface antigen-negative cases

Masaru Kato, Tatsuya Atsumi, Takashi Kurita, Toshio Odani, Yuichiro Fujieda, Kotaro Otomo, Tetsuya Horita, Shinsuke Yasuda, Takao Koike

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

Objective. To evaluate the risk of reactivation of resolved hepatitis B virus (HBV) by immunosuppressive therapy in patients with autoimmune diseases. Methods. Thirty-five patients with autoimmune diseases were included in our study; all were hepatitis B surface antigen (HBsAg)-negative and antibody against hepatitis B core antigen-positive. They were followed for 8-124 weeks and clinical outcomes were analyzed, including serum levels of HBV-DNA and aminotransferase every 4 weeks during their immunosuppressive therapy for underlying autoimmune diseases. If HBV-DNA was detected during the immunosuppressive therapy, HBsAg, antibody against HBsAg (anti-HBs), hepatitis B e antigen (HBeAg), and antibody against HBeAg were also monitored every 4 weeks. Results. HBV-DNA was detected in 6 out of 35 patients. Anti-HBs titer was significantly lower in the patients in whom HBV-DNA was detected compared with the others at baseline: 2.83 (range 0.24-168.50) mIU/ml vs 99.94 (range 0.00-5342.98) mIU/ml, respectively (p = 0.036). Outcomes of the 6 patients with HBV reactivation were as follows: HBV-DNA turned negative in 2 patients without nucleic acid analog (NAA) and 1 with NAA; 2 died due to bacterial sepsis; and 1 died due to autoimmune hemolytic anemia. Significant elevation of aminotransferase was found in only 1 patient, but HBsAg converted to positive in 2 patients and HBeAg converted to positive in 1 patient. Conclusion. Reactivation of resolved HBV can occur during standard immunosuppressive therapy for autoimmune diseases. The low titer of baseline anti-HBs may carry its risk. The Journal of Rheumatology

Original languageEnglish
Pages (from-to)2209-2214
Number of pages6
JournalJournal of Rheumatology
Volume38
Issue number10
DOIs
Publication statusPublished - 2011 Oct 1
Externally publishedYes

Fingerprint

Immunosuppressive Agents
Hepatitis B Surface Antigens
Hepatitis B virus
Autoimmune Diseases
Hepatitis B e Antigens
DNA
Therapeutics
Transaminases
Nucleic Acids
Hepatitis B Core Antigens
Hepatitis B Antibodies
Autoimmune Hemolytic Anemia
Antibodies
Rheumatology
Sepsis
Serum

Keywords

  • Autoimmune diseases
  • Hepatitis B virus
  • Immunosuppression

ASJC Scopus subject areas

  • Rheumatology
  • Immunology and Allergy
  • Immunology

Cite this

Hepatitis B virus reactivation by immunosuppressive therapy in patients with autoimmune diseases : Risk analysis in hepatitis B surface antigen-negative cases. / Kato, Masaru; Atsumi, Tatsuya; Kurita, Takashi; Odani, Toshio; Fujieda, Yuichiro; Otomo, Kotaro; Horita, Tetsuya; Yasuda, Shinsuke; Koike, Takao.

In: Journal of Rheumatology, Vol. 38, No. 10, 01.10.2011, p. 2209-2214.

Research output: Contribution to journalArticle

Kato, Masaru ; Atsumi, Tatsuya ; Kurita, Takashi ; Odani, Toshio ; Fujieda, Yuichiro ; Otomo, Kotaro ; Horita, Tetsuya ; Yasuda, Shinsuke ; Koike, Takao. / Hepatitis B virus reactivation by immunosuppressive therapy in patients with autoimmune diseases : Risk analysis in hepatitis B surface antigen-negative cases. In: Journal of Rheumatology. 2011 ; Vol. 38, No. 10. pp. 2209-2214.
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abstract = "Objective. To evaluate the risk of reactivation of resolved hepatitis B virus (HBV) by immunosuppressive therapy in patients with autoimmune diseases. Methods. Thirty-five patients with autoimmune diseases were included in our study; all were hepatitis B surface antigen (HBsAg)-negative and antibody against hepatitis B core antigen-positive. They were followed for 8-124 weeks and clinical outcomes were analyzed, including serum levels of HBV-DNA and aminotransferase every 4 weeks during their immunosuppressive therapy for underlying autoimmune diseases. If HBV-DNA was detected during the immunosuppressive therapy, HBsAg, antibody against HBsAg (anti-HBs), hepatitis B e antigen (HBeAg), and antibody against HBeAg were also monitored every 4 weeks. Results. HBV-DNA was detected in 6 out of 35 patients. Anti-HBs titer was significantly lower in the patients in whom HBV-DNA was detected compared with the others at baseline: 2.83 (range 0.24-168.50) mIU/ml vs 99.94 (range 0.00-5342.98) mIU/ml, respectively (p = 0.036). Outcomes of the 6 patients with HBV reactivation were as follows: HBV-DNA turned negative in 2 patients without nucleic acid analog (NAA) and 1 with NAA; 2 died due to bacterial sepsis; and 1 died due to autoimmune hemolytic anemia. Significant elevation of aminotransferase was found in only 1 patient, but HBsAg converted to positive in 2 patients and HBeAg converted to positive in 1 patient. Conclusion. Reactivation of resolved HBV can occur during standard immunosuppressive therapy for autoimmune diseases. The low titer of baseline anti-HBs may carry its risk. The Journal of Rheumatology",
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AB - Objective. To evaluate the risk of reactivation of resolved hepatitis B virus (HBV) by immunosuppressive therapy in patients with autoimmune diseases. Methods. Thirty-five patients with autoimmune diseases were included in our study; all were hepatitis B surface antigen (HBsAg)-negative and antibody against hepatitis B core antigen-positive. They were followed for 8-124 weeks and clinical outcomes were analyzed, including serum levels of HBV-DNA and aminotransferase every 4 weeks during their immunosuppressive therapy for underlying autoimmune diseases. If HBV-DNA was detected during the immunosuppressive therapy, HBsAg, antibody against HBsAg (anti-HBs), hepatitis B e antigen (HBeAg), and antibody against HBeAg were also monitored every 4 weeks. Results. HBV-DNA was detected in 6 out of 35 patients. Anti-HBs titer was significantly lower in the patients in whom HBV-DNA was detected compared with the others at baseline: 2.83 (range 0.24-168.50) mIU/ml vs 99.94 (range 0.00-5342.98) mIU/ml, respectively (p = 0.036). Outcomes of the 6 patients with HBV reactivation were as follows: HBV-DNA turned negative in 2 patients without nucleic acid analog (NAA) and 1 with NAA; 2 died due to bacterial sepsis; and 1 died due to autoimmune hemolytic anemia. Significant elevation of aminotransferase was found in only 1 patient, but HBsAg converted to positive in 2 patients and HBeAg converted to positive in 1 patient. Conclusion. Reactivation of resolved HBV can occur during standard immunosuppressive therapy for autoimmune diseases. The low titer of baseline anti-HBs may carry its risk. The Journal of Rheumatology

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