Department of Medicine, Division of Gastroenterology, Hepatology & Nutrition, East Carolina University/ECU Health Medical Center, 601 Moye Blvd, Greenville, NC, 27834, USA.
Research Librarian for the Health Sciences, East Carolina University, Greenville, NC, USA.
Dig Dis Sci. 2023 Dec;68(12):4511-4520. doi: 10.1007/s10620-023-08141-7. Epub 2023 Oct 27.
We and others have previously described that hepatitis B surface antibody (anti-HBs) seems to protect against clinically significant HBV reactivation in cohort studies of patients undergoing anti-tumor necrosis factor (TNF) therapy. However, there were too few cases of HBV reactivation within cohort studies to assess the role of anti-HBs titer on reactivation. The purpose of this study was to systematically review the correlation between anti-HBs titer and the degree of clinically relevant HBV reactivation in patients undergoing anti-TNF therapy.
We systemically reviewed all studies discussing anti-TNF therapy in patients with resolved HBV infection, defined as hepatitis surface antigen (HBsAg) negative and hepatitis B core antibody (anti-HBc) positive. We identified a total of 48 cases of reactivation from 5 cohort studies and 10 case reports or case series; 21 were anti-HBs negative, 7 were only reported as anti-HBs positive, 16 were anti-HBs positive with titer below 100, and 4 were anti-HBs positive with titer above 100. HBsAg sero-reversion was dominantly seen in patients with negative, low and/or declining anti-HBs titers. There was a significant trend toward less clinically relevant form of reactivation with increase in baseline anti-HBs titer (p = 0.022).
Anti-HBs titers greater than 100 iU/L protect against clinically relevant HBV reactivation, while patients with low anti-HBs titers or negative anti-HBs had more clinically relevant HBV reactivation and higher rates of HBsAg sero-reversion. This suggests the importance of baseline quantitative anti-HBs prior to starting anti-TNF therapy and consideration vaccination for boosting anti-HBs titers prior to and/or during therapy.
我们和其他人之前曾描述过，乙型肝炎表面抗体（抗-HBs）似乎可以保护接受抗肿瘤坏死因子（TNF）治疗的患者队列研究中发生临床显著的乙型肝炎病毒（HBV）再激活。然而，队列研究中HBV 再激活的病例太少，无法评估抗-HBs 滴度对再激活的作用。本研究的目的是系统评价抗-HBs 滴度与接受抗 TNF 治疗的患者中临床相关 HBV 再激活程度之间的相关性。
我们系统地回顾了所有讨论 HBV 感染已解决的患者接受抗 TNF 治疗的研究，定义为乙型肝炎表面抗原（HBsAg）阴性和乙型肝炎核心抗体（抗-HBc）阳性。我们从 5 项队列研究和 10 份病例报告或病例系列研究中总共确定了 48 例再激活病例；21 例抗-HBs 阴性，7 例仅报告抗-HBs 阳性，16 例抗-HBs 阳性但滴度低于 100，4 例抗-HBs 阳性但滴度高于 100。HBsAg 血清学转换主要见于抗-HBs 阴性、低滴度和/或滴度下降的患者。随着基线抗-HBs 滴度的增加，HBV 再激活的临床相关性呈下降趋势（p=0.022）。
大于 100 iU/L 的抗-HBs 滴度可预防临床相关的 HBV 再激活，而低滴度或阴性抗-HBs 的患者更易发生临床相关的 HBV 再激活，HBsAg 血清学转换率更高。这表明在开始抗 TNF 治疗之前进行基线定量抗-HBs 检测以及在治疗前和/或治疗期间接种疫苗以提高抗-HBs 滴度非常重要。
