Chronic hepatitis B reactivation and systemic glucocorticosteroid therapy: reply from authors

Abstract

Conflicts of interest: none declared. Sir, We thank Dr Wang and colleagues for their comments on our paper on reactivation of chronic hepatitis B virus (HBV) following systemic glucocorticosteroid therapy that was published in the September 2007 issue of this Journal.1 The authors raise two issues. Firstly, they question whether the hepatitis in four patients described in this article does not represent ‘reactivation’ because they do not have a baseline HBV DNA viral titre for reference, and thus cannot fit the definition of HBV reactivation. Secondly, Wang et al. question the feasibility of antiviral drug prophylaxis therapy as recommended by us. Regarding the first issue, the published article was limited by its scope as a retrospective study. As most dermatologists have traditionally neglected the risk of HBV infection and reactivation during corticosteroid therapy, only 21 of 98 patients (21%) were screened or recorded for serum hepatitis B markers status in this retrospective study. Thus, it was not possible to acquire a baseline HBV DNA viral titre. Even without a baseline HBV DNA viral titre for comparison, however, it is reasonable to conclude that there was a reactivation of HBV in these four patients based on the clinical history and course, as prednisolone is a known risk factor for HBV reactivation, as reported previously.2