Prevalence of Hepatitis B virus serological groups in rheumatoid arthritis and association of previous hepatitis B virus infection with demographic data and parenteral therapies

Abstract

Introduction: The aim of this study is to determine the frequency of Hepatitis b virus (HBV) serological groups in Rheumatoid arthritis (RA) and to compare the demographic characteristics and frequency of parenteral therapies between patient groups with and without previous HBV infection. Methods: Charts of RA patients were examined retrospectively. HBsAg, anti-HBc IgG, and anti-HBs test results were screened. All participants were divided into 3 serological groups (patients naive to HBV infection, previous HBV infection, vaccinated). Those with previous HBV infection were further divided into 3 serological subgroups (naturally immune, anti-HBc IgG positive only, chronic HBV infection). Findings were compared between RA patients with and without previous HBV infection. Results: Four hundred and fifty-one patients (female/male: 343/108) were included. The prevalence of patients naive to HBV infection, with previous HBV infection and vaccinated were 59.4%, 33.7%, and 6.9%, respectively. The prevalence of patients with naturally immune, anti-HBc IgG positive only, and chronic HBV infection were 25.7%, 4.4%, and 3.5%, respectively. Age in RA patients with and without previous HBV infection was 60.8±12.4 and 56.7±14.2 years, respectively(p<0.001). The frequency of previously administered joint injection, subcutaneous and intravenous therapies in RA patients was not different between the groups (p=0.644, p=0.796, and p=0.686, respectively). Conclusions: Chronic HBV infection in RA patients is close to the prevalence in the Turkish population. Previous HBV infection is common in RA and this group is older than those without previous HBV infection. Parenteral therapies in RA treatment options do not change the frequency of HBV exposure.

Keywords

• Rheumatoid arthritis
• Hepatitis B
• parenteral therapies
• anti-HBc Igg

References

1. 1. Schweitzer A, Horn J, Mikolajczyk RT, Krause G, Ott JJ. Estimations of worldwide prevalence of chronic hepatitis B virus infection: a systematic review of data published between 1965 and 2013. Lancet. 2015;386(10003):1546-55.
2. 2. Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2095-128.
3. 3. Tozun N, Ozdogan O, Cakaloglu Y, Idilman R, Karasu Z, Akarca U, et al. Seroprevalence of hepatitis B and C virus infections and risk factors in Turkey: a fieldwork TURHEP study. Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases. 2015;21(11):1020-6.
4. 4. Ramiro S, Gaujoux-Viala C, Nam JL, Smolen JS, Buch M, Gossec L, et al. Safety of synthetic and biological DMARDs: a systematic literature review informing the 2013 update of the EULAR recommendations for management of rheumatoid arthritis. Annals of the rheumatic diseases. 2014;73(3):529-35.
5. 5. Chiu YM, Lai MS, Chan KA. Commensurate incidence and outcomes of liver enzyme elevation between anti-tumor necrosis factor users with or without prior hepatitis B virus infections. PloS one. 2018;13(4):e0196210.
6. 6. Tamori A, Koike T, Goto H, Wakitani S, Tada M, Morikawa H, et al. Prospective study of reactivation of hepatitis B virus in patients with rheumatoid arthritis who received immunosuppressive therapy: evaluation of both HBsAg-positive and HBsAg-negative cohorts. Journal of gastroenterology. 2011;46(4):556-64.
7. 7. Chen YM, Chen HH, Huang WN, Chen YH, Hsieh TY, Yang SS, et al. Reactivation of hepatitis B virus infection following rituximab treatment in HBsAg-negative, HBcAb-positive rheumatoid arthritis patients: A long-term, real-world observation. International journal of rheumatic diseases. 2019;22(6):1145-51.
8. 8. Yilmaz N, Karadag O, Kimyon G, Yazici A, Yilmaz S, Kalyoncu U, et al. Prevalence of hepatitis B and C infections in rheumatoid arthritis and ankylosing spondylitis: A multicenter countrywide study. European journal of rheumatology. 2014;1(2):51-4.

9. 9. Mahroum N, Watad A, Tiosano S, Hejly A, Mahagna H, Waknin R, et al. Chronic hepatitis B viral infection among RA patients-a cross-sectional control study. Clinical rheumatology. 2019;38(5):1237-41.
10. 10. Permin H, Aldershvile J, Nielsen JO. Hepatitis B virus infection in patients with rheumatic diseases. Annals of the rheumatic diseases. 1982;41(5):479-82.
11. 11. Koc OM, Kremer C, Bielen R, Buscchots D, Hens N, Nevens F, et al. Prevalence and risk factors of hepatitis B virus infection in Middle-Limburg Belgium, year 2017: Importance of migration. Journal of medical virology. 2019;91(8):1479-88.
12. 12. Hara A, Matsumoto K, Yokoyama Y, Kizu J. Factorial Analysis of Hepatitis B Virus Reactivation-Induced Hepatitis B Using JADER. Biological & pharmaceutical bulletin. 2017;40(6):782-8.
13. 13. Fukuda W, Hanyu T, Katayama M, Mizuki S, Okada A, Miyata M, et al. Risk stratification and clinical course of hepatitis B virus reactivation in rheumatoid arthritis patients with resolved infection: final report of a multicenter prospective observational study at Japanese Red Cross Hospital. Arthritis research & therapy. 2019;21(1):255.
14. 14. Su FH, Wu CS, Sung FC, Chang SN, Su CT, Shieh YH, et al. Chronic hepatitis C virus infection is associated with the development of rheumatoid arthritis: a nationwide population-based study in taiwan. PloS one. 2014;9(11):e113579.
15. 15. Shim CN, Hwang JW, Lee J, Koh EM, Cha HS, Ahn JK. Prevalence of rheumatoid factor and parameters associated with rheumatoid factor positivity in Korean health screening subjects and subjects with hepatitis B surface antigen. Modern rheumatology. 2012;22(6):885-91.
16. 16. Generali E, De Santis M, Isailovic N, Palermo B, Guidelli GM, Ceribelli A, et al. Rheumatoid factor and anti-citrullinated peptide antibodies in the general population: hepatitis B and C virus association and 15-year-risk of rheumatoid arthritis. Clinical and experimental rheumatology. 2021;39(1):38-43.