Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Changhua Christian Hospital, 135 Nanxiao Street, Changhua City, 500-06, Taiwan.
Division of Gastroenterology, Department of Internal Medicine, Changhua Christian Hospital, Changhua City, Taiwan.
Arthritis Res Ther. 2018 Nov 1;20(1):246. doi: 10.1186/s13075-018-1748-z.
Our aim was to investigate dynamic changes in hepatitis B virus (HBV) surface antibody (HBsAb) titer and the associated risk of HBV reactivation and clinical course in patients with HBV surface antigen negative/core antibody positive (HBsAg/HBcAb) serostatus during antirheumatic therapy with biologic agents.
In a prospective study from January 2013 to June 2017, we monitored the HBV serostatus of HBsAg/HBcAb patients undergoing biologic therapy for rheumatic diseases. From HBsAb titers at baseline and subsequent time points, we calculated the person-years (PY) contributed by patients with different HBsAb levels: < 10 mIU/mL (negative); 10-100 mIU/mL (low); and > 100 mIU/mL (high). We analyzed the incidence of detectable HBV DNA and HBV reactivation in each group, and documented the clinical courses of patients.
Among 380 participants, 83 (21.8%) had baseline HBsAb < 10 mIU/mL, 156 (41.1%) HBsAb 10-100 mIU/mL, and 141 (37.1%) HBsAb > 100 mIU/mL. Total PY at study end were 169.3 PY from the HBsAb-negative group, 362.7 PY from the low-titer group, and 285.8 PY from the high-titer group. Seventeen patients had detectable HBV DNA, with respective incidence rates in negative, low- and high-titer groups of 4.7/100 PY, 2.5/100 PY, and 0/100 PY. Two HBsAb-negative patients subsequently developed HBV reactivation, an incidence of 1.2/100 PY.
The risk of HBV reactivation varied with HBsAb titer, which changed during biologic therapy. Neither HBV DNA nor reactivation were detected in patients with HBsAb > 100 mIU/mL, whereas HBV DNA without reactivation occurred periodically in patients with HBsAb 10-100 mIU/mL; HBsAb-negative serostatus was associated with a risk of HBV reactivation.
本研究旨在探讨在接受生物制剂治疗风湿性疾病的过程中，乙型肝炎病毒（HBV）表面抗体（HBsAb）滴度的动态变化及其与 HBV 再激活和临床病程的关系。
在 2013 年 1 月至 2017 年 6 月期间进行的一项前瞻性研究中，我们监测了接受生物治疗的 HBsAg/HBcAb 患者的 HBV 血清状态。根据基线和后续时间点的 HBsAb 滴度，我们计算了不同 HBsAb 水平患者的人年（PY）贡献：<10 mIU/mL（阴性）；10-100 mIU/mL（低）；和>100 mIU/mL（高）。我们分析了每组中可检测到 HBV DNA 和 HBV 再激活的发生率，并记录了患者的临床病程。
在 380 名参与者中，83 名（21.8%）基线 HBsAb <10 mIU/mL，156 名（41.1%）HBsAb 10-100 mIU/mL，141 名（37.1%）HBsAb >100 mIU/mL。研究结束时，HBsAb 阴性组的总 PY 为 169.3 PY，低滴度组为 362.7 PY，高滴度组为 285.8 PY。17 名患者有可检测到的 HBV DNA，阴性、低和高滴度组的发生率分别为 4.7/100 PY、2.5/100 PY 和 0/100 PY。两名 HBsAb 阴性患者随后发生 HBV 再激活，发生率为 1.2/100 PY。
HBV 再激活的风险随 HBsAb 滴度而变化，并且在生物治疗期间发生变化。HBsAb >100 mIU/mL 的患者未检测到 HBV DNA 或再激活，而 HBsAb 10-100 mIU/mL 的患者定期发生 HBV DNA 无再激活；HBsAb 阴性血清状态与 HBV 再激活的风险相关。
