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Minimal Risk of HBV Reactivation in Resolved HBV-Infected Patients During Immunosuppressive Therapy

21 Pages Posted: 12 Sep 2018

See all articles by Yüksel Gümürdülü

Yüksel Gümürdülü

Cukurova University, Faculty of Medicine, Internal Medicine, Department of Gastroenterology

Salih Tokmak

Cukurova University, Faculty of Medicine, Internal Medicine, Department of Gastroenterology

Ümit Karaoğullarından

Cukurova University, Faculty of Medicine, Internal Medicine, Department of Gastroenterology

Didem Arslan Taş

Cukurova University, Faculty of Medicine, Internal Medicine, Department of Rheumatology

İ. Oğuz Kara

Cukurova University, Faculty of Medicine, Internal Medicine, Department of Oncology

Ahmet Barış Güzel

Cukurova University, Faculty of Medicine, Gynecology and Obstetrics, Department of Gynecologic Oncology

Ghanim Khatib

Cukurova University, Faculty of Medicine, Gynecology and Obstetrics, Department of Gynecologic Oncology

More...

Abstract

Background: Hepatitis B virus reactivation (HBVr) during immunosuppressive drug therapy (ISDT) is a growing concern; however, prospective long-term follow-up studies are rare.

Methods: In this cross-sectional study, we analyzed two groups of patients showing hepatitis B surface antibody (anti-HBs) positivity/HBV surface antigen (HBsAg) negativity among 181 patients receiving immunosuppressive therapy and 141 patients receiving antineoplastic therapy in our tertiary care center. We also analyzed the associated factors and determined the necessity of prophylactic antiviral treatment.

Findings: The mean follow-up time was 17.7 months. We did not detect any cases of HBVr, even among patients receiving rituximab, tumor necrosis factor inhibitors and antineoplastic therapy or in patients with only hepatitis B core antibody (anti-HBc) positivity. Furthermore, we did not find an association between anti-HBs changes and HBVr, although a role for anti-HBs in reactivation has previously been suggested. To examine the association between anti-HBs titers and HBVr, anti-HBs ( ) patients were divided into three subgroups: (i) anti-HBs>1000 mIU/mL (group A), (ii) anti-HBs between 100 and 1,000 mIU/mL (group B) and (iii) anti-HBs between 0 and 100 mIU/mL (group C). A subgroup analysis showed that during the study period, the antibody levels did not change in group A, changed nonsignificantly in group B (p=0.27) and significantly declined in group C (p=0.003).

Interpretation: The risk of reactivation of HBV infection by immunosuppressive and antineoplastic therapy is lower than that suspected in published anecdotal reports.

Funding: None

Declarations of Interest: None

Ethics Approval Statement: This study was performed in accordance with the principles of Good Clinical Practice, the principles of the Declaration of Helsinki and national laws. The study protocol was approved by the local ethics committee.

Keywords: Hepatitis B antigens; immunocompromised host; rituximab; prophylaxis

Suggested Citation

Gümürdülü, Yüksel and Tokmak, Salih and Karaoğullarından, Ümit and Taş, Didem Arslan and Kara, İ. Oğuz and Güzel, Ahmet Barış and Khatib, Ghanim, Minimal Risk of HBV Reactivation in Resolved HBV-Infected Patients During Immunosuppressive Therapy (July 17, 2018). Available at SSRN: https://ssrn.com/abstract=3215516 or http://dx.doi.org/10.2139/ssrn.3215516

Yüksel Gümürdülü (Contact Author)

Cukurova University, Faculty of Medicine, Internal Medicine, Department of Gastroenterology ( email )

Turkey

Salih Tokmak

Cukurova University, Faculty of Medicine, Internal Medicine, Department of Gastroenterology

Turkey

Ümit Karaoğullarından

Cukurova University, Faculty of Medicine, Internal Medicine, Department of Gastroenterology

Turkey

Didem Arslan Taş

Cukurova University, Faculty of Medicine, Internal Medicine, Department of Rheumatology

Turkey

İ. Oğuz Kara

Cukurova University, Faculty of Medicine, Internal Medicine, Department of Oncology

Turkey

Ahmet Barış Güzel

Cukurova University, Faculty of Medicine, Gynecology and Obstetrics, Department of Gynecologic Oncology

Turkey

Ghanim Khatib

Cukurova University, Faculty of Medicine, Gynecology and Obstetrics, Department of Gynecologic Oncology

Turkey