Background/Purpose:

To study the prevalence of occult hepatitis B carrier status and its associated factors in patients with rheumatic diseases undergoing biological therapies

Methods:

Consecutive adult patients with various rheumatic diseases who were currently receiving biological therapies between November 2016 and April 2017 were recruited in this cross-sectional study. Blood was taken for evidence of hepatitis B infection (HBsAg, anti-HBs, anti-HBc-IgG). For patients tested positive for HBsAg or anti-HBc-IgG, assay of serum HBV-DNA level was also performed. Occult hepatitis B carrier was defined as patients who were HBsAg negative but anti-HBc-IgG positive. Logistic regression was performed to study factors independently associated with occult hepatitis B carrier status in these patients.

Results:

310 Chinese patients were studied (60% women, age at biological therapy 44.0±13.0 years). The underlying rheumatic diseases requiring biological therapies were rheumatoid arthritis (46%), spondyloarthritis (31%), psoriatic arthritis (12%) and systemic lupus erythematosus (8.1%). The biologics being used were the TNF inhibitors (66%), tocilizumab (16%), abatacept (2.9%), rituximab (7.7%), belimumab (5.8%) and tofactinib (1.3%). Hepatitis B carrier (HBsAg+) status was detected in 11 (3.5%) patients and they were all put on preemptive anti-viral therapy (entecavir). A total of 105 patients (34%) were occult hepatitis B carriers (HBsAg- but anti-HBc-IgG+). Anti-HBs was present in 83/105 (79%) of these patients. Occult hepatitis B carriers were significantly older than the non-carriers (49.9±11.1 vs 40.9±13.3 years; p<0.001), and were more frequently identified in rheumatoid arthritis than other rheumatic diseases (45% vs 25%; p<0.001). However, there was no gender difference in the prevalence of the occult hepatitis B carrier status (37% in women vs 28% in men; p=0.10). Logistic regression revealed that older age (RR 1.05[1.03-1.08] per year; p<0.001) was the only independent factor significantly associated with occult hepatitis B infection. Rheumatoid arthritis was not significantly associated with occult hepatitis B carrier status after adjustment for age and sex. Of the occult hepatitis B carriers, 9 (8.6%) had detectable HBV-DNA levels but all were very low titers (<100IU/ml). Five (56%) patients with detectable HBV-DNA levels received entecavir treatment during biological therapies, while 19 (20%) patients without detectable HBV-DNA were put on preemptive entecavir treatment (including all patients who were receiving rituximab). None of the overt (HBsAg+) or occult hepatitis B (HBsAg- anti-HBc-IgG+) carrier patients developed clinical reactivation of hepatitis B during a mean of 5.0±3.7 years of biological therapies.

Conclusion:

Occult hepatitis B carrier status was present in one-third of Hong Kong Chinese patients with various rheumatic diseases undergoing biological therapies. Older age was the only independent factor associated with occult hepatitis B infection. Despite the relatively low rate of preemptive anti-viral treatment in these patients, clinical reactivation of hepatitis B was not reported over 5 years of biological therapies.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/prevalence-of-occult-hepatitis-b-carrier-status-and-its-associated-risk-factors-in-patients-with-rheumatic-diseases-undergoing-biological-therapies/