Background/Purpose: Torque teno virus (TTV) is an endogenous anellovirus that is highly prevalent in adult healthy subjects (up to 90%) without known pathogenicity. Increased replication has been associated to immunosuppression, leading to higher viral loads in patients with HIV infection or in transplanted patients on immunosuppression. Therefore, it has been proposed as an indirect marker of immunosuppression with potential predictive value of infectious complications.

The aim of our study was to analyze whether the biologic agents used in the treatment of chronic arthritis induce an increase in TTV viremia, compared to healthy controls and to patients with arthritis on conventional DMARD.

Methods: A cross-sectional study was performed in 79 patients with chronic arthritis on biologic therapy (58 rheumatoid arthritis and 21 spondyloarthritis). In a single visit, clinical and analytical data were collected, and a plasma sample was obtained for the analysis of viremia (TTV DNA load assessed by quantitative PCR). A group of 54 healthy individuals sex and age matched, and a group of 23 patients with chronic arthritis treated with conventional DMARDs (leflunomide and/or methotrexate) were used as control groups. In another group of 29 patients with chronic arthritis starting biologic therapy, a longitudinal study was performed, comparing baseline and follow-up (after 4 months on biologic) samples. Mean TTV viremia in the different groups was compared using ANOVA with Dunnett’s multiple comparison test. Correlation between different quantitative variables and viremia was analyzed by the Spearman or Pearson test where appropriate. Mean viremia in groups stratified by different qualitative variables was compared using the Student’s t-test, defining p <0.05 as statistically significant.

Results: In the cross-sectional sample of 79 patients, TTV load was significantly higher in abatacept, infliximab and tocilizumab groups compared to healthy and to arthritic DMARD groups (ANOVA p <0.0001). Healthy and arthritic patients treated with DMARD showed similar TTV loads. Patients on rituximab did not show an increased TTV load compared to the control groups. In the group of patients longitudinally analyzed, there was a significant increase in the TTV load after 4 months of biologic compared to the baseline (pre-biologic) sample (p=0.042). Significant correlations between the TTV load and the clinical or analytical variables analyzed (age, disease duration, concomitant glucocorticoid or DMARD therapy, diabetes, CRP, ESR, lymphocytes, disease activity) were not found. Patients with previous history of severe infection did not have higher levels of TTV viremia.

Conclusion: Patients with chronic arthritis on therapy with abatacept, tocilizumab or anti-TNF have an increased TTV viremia compared to arthritic on conventional DMARD or to healthy control groups, while it was similar in patients treated with rituximab. TTV viremia was similar in patients with arthritis on DMARD compared to healthy controls. In this population, no correlation between TTV viremia and other clinical or analytical factors was found.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/influence-of-the-treatment-with-biologic-agents-in-the-viremia-by-the-endogenous-anelovirus-torque-teno-virus-in-patients-with-chronic-arthritis/