Stasi Cristina, Tiengo Giacomo, Sadalla Sinan, Zignego Anna Linda
MASVE Interdepartmental Hepatology Center, Department of Experimental and Clinical Medicine, University of Florence and CRIA-MASVE Center for Research and Innovation, Careggi University Hospital, 50134 Florence, Italy.
Epidemiology Unit, Regional Health Agency of Tuscany, 50141 Florence, Italy.
J Clin Med. 2021 Jun 10;10(12):2564. doi: 10.3390/jcm10122564.
Chronic hepatitis B virus (HBV) flares or reactivations are serious causes of morbidity or mortality in rheumatologic patients undergoing immunosuppressive therapy. The recent insights in the pathogenesis of rheumatic diseases led to the use of new immunosuppressive therapies indicated in case of failure, partial response, or intolerance of conventional synthetic disease-modifying anti-rheumatic drugs. Based on these premises, this review examines and discusses the main rheumatologic treatments that could require the initiation of prophylactic treatment or close monitoring of occult HBV infection in patients beginning antiviral therapy at the first signs of HBV reactivation, or antiviral treatment in chronic HBV-infected patients. We searched for relevant studies published in the last five years. Studies suggested that the presence of HBV infection is common in rheumatic patients and HBV reactivation during these immunosuppressant treatments is quite frequent in these kinds of patients. Therefore, before starting an immunosuppressive therapy, patients should be screened for HBsAg, anti-HBs, and anti-HBc and, on the basis of markers positivity, they should be carefully characterized for HBV infection phases. In conclusion, screening of HBV infection in patients undergoing immunosuppressive therapy with subsequent HBV monitoring, prophylaxis or treatment consistently reduces the risk of clinical consequences.
慢性乙型肝炎病毒（HBV）发作或再激活是接受免疫抑制治疗的风湿性疾病患者发病或死亡的严重原因。风湿性疾病发病机制的最新见解促使人们使用新的免疫抑制疗法，这些疗法适用于传统合成抗风湿药物治疗失败、部分缓解或不耐受的情况。基于这些前提，本综述探讨并讨论了主要的风湿性疾病治疗方法，这些治疗可能需要对开始抗病毒治疗的患者进行预防性治疗或密切监测隐匿性HBV感染，一旦出现HBV再激活的最初迹象即开始抗病毒治疗，或者对慢性HBV感染患者进行抗病毒治疗。我们检索了过去五年发表的相关研究。研究表明，HBV感染在风湿性疾病患者中很常见，在这些免疫抑制治疗期间，这类患者中HBV再激活相当频繁。因此，在开始免疫抑制治疗前，应对患者进行HBsAg、抗-HBs和抗-HBc筛查，并根据标志物阳性情况，仔细确定其HBV感染阶段。总之，对接受免疫抑制治疗的患者进行HBV感染筛查，并随后进行HBV监测、预防或治疗，可持续降低临床后果的风险。
