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Reactivation of hepatitis B viral infection in inactive HBsAg carriers following anti-tumor necrosis factor-alpha therapy

Authors
 SOO-JIN CHUNG  ;  JA KYUNG KIM  ;  MIN-CHAN PARK  ;  YONG-BEOM PARK  ;  SOO-KON LEE 
Citation
 JOURNAL OF RHEUMATOLOGY, Vol.36(11) : 2416-2420, 2009 
Journal Title
 JOURNAL OF RHEUMATOLOGY 
ISSN
 0315-162X 
Issue Date
2009
MeSH
Adult ; Alanine Transaminase/blood ; Antibodies, Monoclonal/adverse effects ; Antibodies, Monoclonal/immunology ; Antibodies, Monoclonal/therapeutic use ; Antirheumatic Agents*/adverse effects ; Antirheumatic Agents*/immunology ; Antirheumatic Agents*/therapeutic use ; Arthritis/blood ; Arthritis/drug therapy ; Arthritis/immunology ; Arthritis/virology ; Aspartate Aminotransferases/blood ; Carrier State* ; Female ; Hepatitis B/blood ; Hepatitis B/immunology* ; Hepatitis B Surface Antigens/immunology* ; Hepatitis B virus/immunology ; Humans ; Infliximab ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Tumor Necrosis Factor-alpha/antagonists & inhibitors* ; Tumor Necrosis Factor-alpha/immunology ; Viral Load ; Virus Activation/immunology* ; Young Adult
Abstract
OBJECTIVE: To investigate whether anti-tumor necrosis factor-alpha (TNF-alpha) 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-alpha therapy were reviewed retrospectively. Data on seropositivity of HBV, HBV load, and serum aminotransferases prior to and after initiation of anti-TNF-alpha 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-alpha therapy. Reactivation of hepatitis B occurred in 1 patient during the course of anti-TNF-alpha 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-alpha 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
Full Text
http://www.jrheum.org/content/36/11/2416.long
DOI
10.3899/jrheum.081324
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Ja Kyung(김자경) ORCID logo https://orcid.org/0000-0001-5025-6846
Park, Min Chan(박민찬) ORCID logo https://orcid.org/0000-0003-1189-7637
Park, Yong Beom(박용범)
Lee, Soo Kon(이수곤)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/105365
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