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|標題:||Kinetics of viral loads and risk of hepatitis B virus reactivation in hepatitis B core antibody-positive rheumatoid arthritis patients undergoing anti-tumour necrosis factor alpha therapy||作者:||Lan, J.L.
|關鍵字:||low-dose methotrexate;immunosuppressive therapy;cytotoxic;chemotherapy;influenza vaccination;fulminant-hepatitis;hbv;reactivation;blocking agents;infection;tnf;lamivudine||Project:||Annals of the Rheumatic Diseases||期刊/報告no：:||Annals of the Rheumatic Diseases, Volume 70, Issue 10, Page(s) 1719-1725.||摘要:||
Objective To investigate the kinetics of hepatitis B virus (HBV) viral loads and HBV reactivation in rheumatoid arthritis (RA) patients undergoing therapy with tumour necrosis factor alpha (TNF alpha) inhibitors. Methods The authors investigated the virological, serological and biochemical evidence of HBV reactivation in 88 RA patients receiving anti-TNF alpha therapy. Levels of HBV surface (HBs) antigen (Ag), anti-HBV core (HBc)-IgG and anti-HBs antibody (Ab) were detected by electrochemiluminescence immunoassay, and viral loads were determined by real-time PCR assay. Results In a total of 88 HBcAb-positive patients, 18 (20.5%) patients were HBsAg-positive, 12 (13.6%) patients were HBsAg-negative/HBsAb-negative and 58 (65.9%) patients were HBsAg-negative/HBsAb-positive before starting anti-TNF alpha therapy. Among HBsAg-positive patients receiving anti-TNF alpha therapy, HBV reactivation was documented in none of 10 patients who received lamivudine pre-emptive therapy and serum viral loads significantly decreased (mean +/- SEM, 153 860 +/- 80 120 IU/ml at baseline vs 313 +/- 235 IU/ml after 12 months antiviral therapy, p<0.001), paralleling the decrease in serum aminotransferase levels. In contrast, five (62.5%) of eight patients without antiviral prophylaxis developed HBV reactivation, viral loads significantly increased after anti-TNF alpha therapy (9375 +/- 5924 IU/ml vs 49 710 000 +/- 40 535 000 IU/ml, p<0.001), and markedly declined after antiviral therapy (49 710 000 +/- 40 535 000 IU/ml vs 6382 +/- 2424 IU/ml, p<0.001). Baseline viral loads were detectable in four (33.3%) of 12 patients who had HBsAg-negative/HBsAb-negative status, and one developed HBV reactivation after anti-TNF alpha therapy. Conclusion HBV reactivation can occur in both HBsAg-positive and HBsAg-negative/HBcAb-positive patients with detectable HBV DNA, so-called occult HBV infection, during anti-TNF alpha therapy. Antiviral prophylaxis may effectively reduce HBV reactivation in HBsAg-positive RA patients undergoing anti-TNF alpha therapy.
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