Evaluation of HBV Reactivation and Antiviral Prophylaxis in Patients Receiving Immunosuppressive Therapy

Year 2023, Volume: 13 Issue: 5, 809 - 813, 30.09.2023

Ahmet Şahin , Selda Aslan

https://doi.org/10.16899/jcm.1343166

Abstract

Aim: Patients with chronic hepatitis B and people with a history of hepatitis B (HBV) infection are at risk of HBV reactivation (HBVr) when they receive immunosuppressive therapy. In this study, we aimed to evaluate the hepatitis B serology, risk groups and antiviral prophylaxis of patients receiving various immunosuppressive therapies due to rheumatological diseases.
Material and Method: The study included 375 patients over 18 years of age who received tumor necrosis factor-α (TNF-α) inhibitor, tyrosine kinase inhibitor, steroids, methotrexate or anti-CD20 antibodies due to rheumatic diseases in a training and research hospital between May 2022 and May 2023. Hepatitis B surface antigen (HbsAg), hepatitis B surface antibody (anti-Hbs), hepatitis B core protein antibody (anti-Hbc IgG) serologies, immunosuppressive therapies and oral antivirals were retrospectively analyzed.
Results: The average age of the 375 patients included in the study was 43.77±13.07 years. 193 (51.5%) of the patients were male. 11 patients were HbsAg positive, 150 patients were anti-Hbs positive, 19 patients were isolated anti-Hbc IgG positive, and 79 patients were both anti-Hbs and anti-Hbc IgG positive. According to serological findings, 109 (29%) patients had HBV exposure. All three test results of 194 (51.7%) patients were negative. A total of 85 (22.7%) patients received oral antiviral prophylaxis due to the use of immunosuppressive agents. In terms of HBVr, 16.5% were evaluated as high risk, 75.3% as moderate risk, and 8.2% as low risk. Out of 85 patients 79 received entecavir, 5 reveived tenofovir disoproxil fumarate (TDF) and 1 received tenofovir alafenamide fumarate (TAF). The mean duration for the immunosuppressive therapy was 6.41±4.20 years. The mean duration of oral antiviral prophylaxis among patients was 1.02±1.72 years. HBVr was not observed in any of our patients.
Conclusion: Before patients receive immunosuppressive therapy, hepatitis B serologies and prophylaxis indication should be evaluated firstly. In addition, as a preventive medicine activity, hepatitis B vaccinations of unvaccinated patients should be completed as quickly as possible.

Keywords

Immunosuppression, hepatitis B, reactivation

Supporting Institution

No financial or non-financial benefits have been received or will be received from any party related directly or indirectly to the subject of this article.

Thanks

We thank the physicians of the rheumatology clinic.

İmmunsupresif Tedavi Alan Hastalarda HBV Reaktivasyonu ve Antiviral Profilaksinin Değerlendirilmesi

Abstract

Amaç: Kronik hepatit B’li hastalar ve geçirilmiş hepatit B virüs enfeksiyonu olan kişiler immünsupresif tedavi aldıkları zaman HBV reaktivasyonu riskine maruz kalırlar. Bu çalışmada romatolojik hastalıklar nedeni ile çeşitli immünsupresif tedavileri alan hastaların hepatit B serolojilerini, risk gruplarını ve antiviral profilaksi alma durumlarını sunmayı amaçladık.
Gereç ve Yöntem: Çalışmaya Mayıs 2022 ile Mayıs 2023 tarihleri arasında bir eğitim ve araştırma hastanesinde romatolojik hastalıklar nedeni ile tümör nekroz faktör-α inhibitörü, tirozin kinaz inhibitörü, steroid, metotreksat veya anti-CD20 antikoru alan 18 yaş üstü 375 hasta dahil edildi. Hastaların HbsAg, anti-Hbs ve anti-Hbc IgG serolojileri, immünsupresif tedavileri ve süresi ile almış oldukları oral antiviraller retrospektif olarak incelendi.
Bulgular: Çalışmaya alınan 375 hastanın yaş ortalaması 43.77±13.07 idi. Hastaların 193’ ü (%51.5) erkek idi. Hastaların 11’ inde HbsAg pozitif, 150’ sinde anti Hbs pozitif, 19’ unda izole anti-Hbc IgG pozitif ve 79 hastada ise anti-Hbs ile anti-Hbc IgG beraber pozitif idi. Serolojik bulgulara göre 109 (%29) hastada HBV ile karşılaşma durumu mevcuttu. 194 (%51.7) hastanın ise her üç tetkik sonucu da negatif idi. Toplamda 85 (%22.7) hasta immünsupresif ajan kullanımı nedeni ile oral antiviral profilaksi almaktaydı. HBV reaktivasyon riski profilaksi başlanan hastaların 14’ ünde (%16.5) yüksek, 64’ ünde (%75.3) orta, 7’ sinde (%8.2) düşük riskliydi. 79 hasta entekavir, 5 hasta tenofovir disoproksil fumarat ve 1 hasta ise tenofovir alafenamid fumarat almakta idi. Ortalama immünsüpresif tedavi alma süresi 6.41±4.20 yıl idi. Hastaların oral antiviral profilaksi alma süreleri ise ortalama 1.02±1.72 yıl idi. HBV reaktivasyonu görülen hastamız olmadı.
Sonuç: Hastalar immünsupresif tedavi almadan önce hepatit B serolojileri ve profilaksi durumları öncelikle değerlendirilmelidir. Ayrıca koruyucu hekimlik faaliyeti olarak aşısız hastaların en kısa sürede hepatit B aşıları tamamlanmalıdır.

Keywords

İmmünsupresyon, hepatit B, reaktivasyon

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