Minimal Risk of HBV Reactivation in Resolved HBV-Infected Patients During Immunosuppressive Therapy

Abstract

Background: Hepatitis B virus reactivation (HBVr) during immunosuppressive drug therapy (ISDT) is a growing concern; however, prospective long-term follow-up studies are rare. Methods: In this cross-sectional study, we analyzed two groups of patients showing hepatitis B surface antibody (anti-HBs) positivity/HBV surface antigen (HBsAg) negativity among 181 patients receiving immunosuppressive therapy and 141 patients receiving antineoplastic therapy in our tertiary care center. We also analyzed the associated factors and determined the necessity of prophylactic antiviral treatment. Findings: The mean follow-up time was 17.7 months. We did not detect any cases of HBVr, even among patients receiving rituximab, tumor necrosis factor inhibitors and antineoplastic therapy or in patients with only hepatitis B core antibody (anti-HBc) positivity. Furthermore, we did not find an association between anti-HBs changes and HBVr, although a role for anti-HBs in reactivation has previously been suggested. To examine the association between anti-HBs titers and HBVr, anti-HBs ( ) patients were divided into three subgroups: (i) anti-HBs>1000 mIU/mL (group A), (ii) anti-HBs between 100 and 1,000 mIU/mL (group B) and (iii) anti-HBs between 0 and 100 mIU/mL (group C). A subgroup analysis showed that during the study period, the antibody levels did not change in group A, changed nonsignificantly in group B (p=0.27) and significantly declined in group C (p=0.003). Interpretation: The risk of reactivation of HBV infection by immunosuppressive and antineoplastic therapy is lower than that suspected in published anecdotal reports. Funding: None Declarations of Interest: None Ethics Approval Statement: This study was performed in accordance with the principles of Good Clinical Practice, the principles of the Declaration of Helsinki and national laws. The study protocol was approved by the local ethics committee.