Prevalence of Hepatitis B Infection is Lower in Patients with Systemic Lupus Erythematosus but is Associated with a High Risk of Hepatic Failure and Hepatocellular Carcinoma

Abstract

Objective: In patients with concomitant systemic lupus erythematosus (SLE) and hepatitis B virus (HBV) infection, HBV reactivation is a persisting concern. However, data regarding the prevalence and clinical outcomes of HBV infection in patients with SLE remains limited. Our study aimed to clarify the prevalence and prognosis of HBV infection in SLE patients. Methods: In this retrospective cohort study, we reviewed the medical records of SLE patients admitted in 2011-2013 to the National Taiwan University Hospital. Age, gender, disease duration, medication history, and hepatitis B virus-related outcomes-such as hepatitis, cirrhosis, and hepatocellular carcinoma-were documented for statistical analyses. Results: A total 268 patients with SLE were included in the study. Of these, 22 patients were HBs-Agpositive, and the prevalence of HBV infection was 8.2%. As compared to the HBs-Ag-negative group, the hazard ratios (HRs) of hepatic failure (HR=105.12; p＜0.0001), liver-related mortality (HR=46.97 p=0.0006), and hepatocellular carcinoma (HR=24.37; p=0.0094) were significantly higher in the HBs-Agpositive patients. The mean prednisolone dose was 12.50 (7.50-17.50) mg/day in the hepatic failure group and 5.00 (0.50-10.00) mg/day in the non-hepatic failure group; this difference in the prednisolone dose was significant (p=0.0106). Conclusions: The prevalence of HBV infection in SLE patients was lower than that in the general population in Taiwan; however, hepatitis B infection in SLE patients was associated with a high risk of poor hepatic outcomes, such as hepatic failure and hepatocellular carcinoma. The risk of hepatic failure increased when SLE patients with HBV infection received steroids at a dose higher than low dose regimens. Hepatitis status in SLE patients should therefore be closely monitored.