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SAT0140 Prevalence of Reactivation of Hepatitis B Virus (HBV) in Patients with Resolved Hbv Hepatitis on Immunosuppressive Therapy for Rheumatic Disease: Multicentre Prospective Observational Study in Japan
  1. W. Fukuda1,
  2. T. Hanyu2,
  3. M. Katayama3,
  4. A. Okada4,
  5. S. MIzuki5,
  6. M. Miyata6,
  7. Y. Handa7,
  8. M. Hayashi8,
  9. Y. Koyama9,
  10. K. Arii10,
  11. T. Kitaori11,
  12. H. Hagiyama12,
  13. Y. Urushidani13,
  14. T. Yamazaki14,
  15. Y. Ikeno15,
  16. T. Suzuki16,
  17. S. Inokuma16
  1. 1Cnter for Rheumatic Disease, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto
  2. 2Department of Rheumatology, Nagaoka Red Cross Hospital, Niigata
  3. 3Department of Rheumatology, Osaka Red Cross Hospital, Osaka
  4. 4Department of Rheumatology, Department of Rheumatology, Nagasaki
  5. 5Department of Rheumatology, Matsuyama Red Cross Hospital, Matsuyama
  6. 6Department of Internal Medicine, Japanese Red Cross Fukushima Hospital, Fukushima
  7. 7Department of Rheumatology, Saitama Red Cross Hospital, Saitama
  8. 8Department of Orthopedics, Nagano Red Cross Hospital, Nagano
  9. 9Department of Rheumatology, Japanese Red Cross Okayama Hospital, Okayama
  10. 10Department of Internal Medicine, Japanese Red Cross Kochi Hospital, Kochi
  11. 11Department of Orthopedics, Japanese Red Cross Fukui Hospital, Fukui
  12. 12Department of Rheumatology, Yokohama City Minato Red Cross Hospital, Yokohama
  13. 13Department of Rheumatology, Matsue Red Cross Hospital, Matsue
  14. 14Department of Rehabilitation, Japanese Red Cross Kyoto Daini Hospital, Kyoto
  15. 15Department of Rheumatology, Nasu Red Cross Hospital, Ootahara
  16. 16Department of Allergy and Rheumatic Diseases, Japanese Red Cross Medical Center, Tokyo, Japan

Abstract

Background Although the reactivation of hepatitis B virus (HBV) is recognized as a serious complication in patients with connective tissue disease (CTD) receiving immunosuppressive drugs (ISDs), the incidence and risk factors of reactivation remain controversial.

Objectives We performed a multicentre, observational, prospective study across 16 Japanese Red Cross hospitals to clarify the prevalence and pathophysiology of HBV reactivation in patients with CTD. We report the results of 2-year observations in patients with resolved HBV infection.

Methods Patients with CTD, treated with a dose of ≥5 mg/day prednisolone, and/or synthetic or biological ISDs, with negative HBs antigen and positive anti HBs and/or HBc antibody (Ab), were enrolled. HBV-DNA (RT-PCR) and related data were registered regularly.

Results Among 1040 patients, including 950 rheumatoid arthritis, HBV-DNA was detected in 32 patients (1.75/100 person-years), and >2.1 log copy/ml was observed in 9 cases (0.49/100 person-years) over 1–2 years of observation. None of the reactivated patients, including six treated with a nucleic acid analogue, showed overt hepatitis. Low HBs Ab titres and advanced age seemed to be risk factors for HBV reactivation; however, reactivation was observed in 3 patients with positive HBs Ab and negative HBc Ab. The risk of reactivation among the different types of ISDs was not statistically different. The intervals from the start of ISD to reactivation were longer than previous reports (4–157 months, average 58.9 months).

Conclusions HBV reactivation with ISD was 1.75/100 person-years in CTD patients with resolved HBV infection. Overt hepatitis was observed in none of the reactivated patients, and low HBs antibody titres and advanced age were risk factors for reactivation. Patients with positive HBs Ab and negative HBc Ab are not free from the risk of reactivation of HBV.

  1. B. J Hepatol 2012: 57. 167–185

Disclosure of Interest None declared

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