Monitoring by viral load and quantitative hepatitis B surface antigen in patients with hepatitis B virus infection receiving immunosuppressive therapy. Issue 1 (January 2021)

• Record Type: Journal Article
• Authors: Yu, Hsien-Chung; Tseng, Jui-Cheng; Lu, Ling-Ying; Hu, Jwi-Chieh; Chen, Yan-Hua; Hsu, Chiao-Lin; Wu, Pin-Chieh; Mar, Guang-Yuan; Lin, Kung-Hung
• Is Part Of: European journal of gastroenterology & hepatology. Volume 33:Issue 1(2021)
• Publication Date: 2021-01
• Subjects: autoimmune disease -- hepatitis B virus -- immunosuppressive therapy -- reactivation -- steroid; Digestive organs -- Diseases -- Periodicals; Liver -- Diseases -- Periodicals; Digestive organs -- Diseases; Liver -- Diseases; Periodicals; 616.33
• DOI: 10.1097/MEG.0000000000001707
• Languages: English
• ISSNs: 0954-691X

Abstract

Abstract : Objectives: Hepatitis B virus reactivation in patients on immunosuppressive therapy is a critical issue. We aimed to verify the monitoring strategies of hepatitis B virus DNA and quantitative hepatitis B surface antigen in patients receiving therapies with moderate risk. Methods: We enrolled 25 patients with autoimmune diseases receiving immunosuppressive therapy. Liver function, hepatitis B virus DNA, and quantitative hepatitis B surface antigen were followed-up every 2 months for 24 months. The hepatitis B virus reactivation was defined as hepatitis B virus DNA reappearance or increase of >1 log IU/mL. Results: Patients who were hepatitis B surface antigen positive with (n = 12) or without (n = 6) antiviral prophylaxis and hepatitis B surface antigen negative (n = 7) were analyzed, and the reactivation rates were 0%, 50% and 14%, respectively. Antiviral prophylaxis prevented hepatitis B virus reactivation in hepatitis B surface antigen-positive patients ( P = 0.025). Administration of high-risk steroid doses was the sole factor related to the sign of quantitative hepatitis B surface antigen increase of >0.5 log IU/mL in the first 12 months ( P = 0.035, risk ratio = 0.098, 95% confidence interval = 0.011–0.847). Furthermore, no patient experienced hepatic decompensation or failure. Conclusion: Monitoring hepatitis B virus DNA and quantitative hepatitis B surface antigen every 2 months is safe. However, antiviral prophylaxis can prevent hepatitis B virus reactivation. For patients under steroid therapy in high-risk doses, quantitative hepatitis B surface antigen increase of >0.5 log IU/mL may signify hepatitis B virus reactivation.