Nard Francesca De, Todoerti Monica, Grosso Vittorio, Monti Sara, Breda Silvia, Rossi Silvia, Montecucco Carlomaurizio, Caporali Roberto
Francesca De Nard, Monica Todoerti, Vittorio Grosso, Sara Monti, Silvia Breda, Silvia Rossi, Carlomaurizio Montecucco, Roberto Caporali, IRCCS Policlinico San Matteo Foundation, Chair and Division of Rheumatology, University of Pavia, 27100 Pavia, Italy.
World J Hepatol. 2015 Mar 27;7(3):344-61. doi: 10.4254/wjh.v7.i3.344.
Hepatitis B virus (HBV) reactivation in rheumatoid arthritis (RA) patients undergoing biological therapy is not infrequent. This condition can occur in patients with chronic hepatitis B as well as in patients with resolved HBV infection. Current recommendations are mainly focused on prevention and management strategies of viral reactivation under tumor necrosis factor-α inhibitors or chimeric monoclonal antibody rituximab. In recent years, growing data concerning HBV reactivation in RA patients treated with newer biological drugs like tocilizumab and abatacept have cumulated. In this review, epidemiology, pathogenesis and natural history of HBV infection have been revised first, mainly focusing on the role that specific therapeutic targets of current biotechnological drugs play in HBV pathobiology; finally we have summarized current evidences from scientific literature, including either observational studies and case reports as well, concerning HBV reactivation under different classes of biological drugs in RA patients. Taking all these evidences into account, some practical guidelines for screening, vaccination, prophylaxis and treatment of HBV reactivation have been proposed.
接受生物治疗的类风湿关节炎（RA）患者中，乙型肝炎病毒（HBV）再激活并不罕见。这种情况可发生于慢性乙型肝炎患者以及HBV感染已康复的患者。目前的建议主要集中在肿瘤坏死因子-α抑制剂或嵌合单克隆抗体利妥昔单抗治疗下病毒再激活的预防和管理策略。近年来，有关使用托珠单抗和阿巴西普等新型生物药物治疗的RA患者中HBV再激活的越来越多的数据不断积累。在这篇综述中，首先回顾了HBV感染的流行病学、发病机制和自然史，主要关注当前生物技术药物的特定治疗靶点在HBV病理生物学中所起的作用；最后，我们总结了科学文献中的现有证据，包括观察性研究和病例报告，涉及RA患者在不同类别生物药物治疗下的HBV再激活情况。考虑到所有这些证据，我们提出了一些关于HBV再激活筛查、疫苗接种、预防和治疗的实用指南。
