Background Reactivation of HBV is well-recognized and frequently reported in rheumatic patients, particularly those receiving disease modifying anti-rheumatic drugs [1, 2]. This might occur during  or after  cessation of chronic immunosuppressive therapy. Hepatitis B surface antigen (HBsAg), hepatitis B core antibody (anti-HBc) are considered as the classic assays for identification of HBV infection . Never the less, epidemiological studies concerning the prevalence of anti-HBc in various rheumatic diseases have not been reported previously in literature.
Objectives To determine the prevalence of anti-HBc and HBsAg among patients referred to a rheumatology outpatient clinic in northern Italy between December 2011 and December 2012.
Methods This is an ongoing study, in which 205 patients (129 female; mean age 57± 14), with different rheumatic diseases were screened for HBV infection. All were tested for anti-HBc as well as for HBsAg if anti-HBc positive.
Results Among the 205 studied patients, anti-HBc was detected in 46/205 (22.4%), and 5 patients (10.9%) were also positive for HBsAg. Anti-HBc positivity showed a comparable prevalence among male and female patients (25%, 20.9% respectively). Patients were diagnosed as rheumatoid arthritis (n=85), psoriatic arthritis (n=31), spondyloarthritis (n=27), undifferentiated connective tissue disease (n=15) and other rheumatologic diseases (n=78) lasting for a mean of 5 years. The highest prevalence of anti-HBc was observed in patients with scleroderma (50%) followed by polymyalgia rheumatica (43%), spondyloarthritis (37%), undifferentiated connective tissue disease (33%), psoriatic arthritis (32%) and sjögren’s syndrome (25%). On the other hand, the lowest prevalence of anti-HBc was observed in rheumatoid arthritis (13%) and ankylosing spondylitis (14%).
Conclusions About one fourth of rheumatic patients are anti-HBc positive with a prevalence ranging from 13 to 50% across various rheumatic pathologies. Screening for a resolved or active HBV infection is mandatory for all patients with rheumatic diseases especially if they are candidates for an immunosuppressive therapy. Our data strongly encourage further studies with larger sample sizes to elucidate the possible role of HBV in the pathogenesis of certain rheumatic diseases.
Ohishi W, Chayama K. Prevention of hepatitis B virus reactivation in immunosuppressive therapy or chemotherapy. Clin Exp Nephrol. 2011; 15: 634-40
Nunes J, Marinho RT, Fonseca JE, Pereira da Silva JA, Velosa J. Prophylaxis of hepatitis B reactivation with immunosuppressive therapy in rheumatic diseases. Orientations for clinical practice. Acta Reumatol Port. 2011; 36: 110-8.
Dai MS, Chao TY, Kao WY, Shyu RY, Liu TM. Delayed hepatitis B virus reactivation after cessation of preemptive lamivudine in lymphoma patients treated with rituximab plus CHOP. Ann Hematol. 2004; 83: 769–74.
Disclosure of Interest None Declared
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