Department of Gastroenterology, Internal Medicine, Çukurova University School of Medicine, Adana, Turkey.
Department of Rheumatology, Internal Medicine, Çukurova University School of Medicine, Adana, Turkey.
Turk J Gastroenterol. 2021 Mar;32(3):294-301. doi: 10.5152/tjg.2021.201131.
Reactivation of Hepatitis B (HBVr) related to immunosuppressive drug therapy (ISDT) in patients with resolved and past infection is a challenging entity. The number of prospective long-term studies is limited.
Two groups of patients with resolved and past HBV infection were analyzed prospectively. The patients were further categorized as 266 patients receiving ISDT (group 1) and 246 patients receiving antineoplastic therapy (group 2).
We did not detect any cases of HBVr among 108 patients receiving rituximab (71 of which were anti-HBc positive only), 111 patients receiving tumor necrosis factor inhibitors (66 of which were anti-HBc positive only), and 42 patients receiving high-dose glucocorticoids for more than 4 weeks (24 of which were anti-HBc positive only) during a mean follow-up time of more than 24 months. Subgroup analysis of the anti-HBs (+) patients showed that in group A (anti-HBs >1000 mIU/mL) the antibody levels did not change; in group B (anti-HBs between 100 and 1000 mIU/mL) the antibody levels changed non-significantly (P = .25), and in Group C (anti-HBs between 0 and 100 mIU/mL) the antibody levels declined significantly (P = .002). Furthermore, 16 patients in Group C had an anti-HBs loss during follow-up, but no HBVr was detected.
The risk of HBVr by immunosuppressive therapy in this group may be lower than that suspected in the literature and anti- HBs levels may not seem to correlate with the risk of reactivation.
在已痊愈和既往感染的患者中，因免疫抑制药物治疗（ISDT）而导致乙型肝炎病毒（HBV）再激活（HBVr）是一个具有挑战性的问题。前瞻性长期研究的数量有限。
我们前瞻性地分析了两组已痊愈和既往 HBV 感染的患者。这些患者进一步分为接受 ISDT 的 266 例患者（第 1 组）和接受抗肿瘤治疗的 246 例患者（第 2 组）。
在接受利妥昔单抗（71 例仅为抗 HBc 阳性）、肿瘤坏死因子抑制剂（66 例仅为抗 HBc 阳性）和高剂量糖皮质激素（42 例仅为抗 HBc 阳性）治疗的 108 例患者中，我们未发现任何 HBVr 病例，中位随访时间超过 24 个月。对抗-HBs（+）患者进行亚组分析显示，在 A 组（抗-HBs＞1000 mIU/mL）中，抗体水平未发生变化；在 B 组（抗-HBs 在 100-1000 mIU/mL 之间）中，抗体水平无显著变化（P＝.25），在 C 组（抗-HBs 在 0-100 mIU/mL 之间）中，抗体水平显著下降（P＝.002）。此外，C 组中有 16 例患者在随访期间出现抗-HBs 丢失，但未检测到 HBVr。
在该组中，免疫抑制治疗导致 HBVr 的风险可能低于文献中所怀疑的风险，且抗-HBs 水平似乎与再激活的风险无关。
