Abstract
BackgroundBy determining the hepatitis B virus (HBV) surface antigen (HBsAg) positive rate postexposure and HBV-specific antigen/antibody (Ag/Ab) level in patients with rheumatic diseases, we aimed at exploring the rheumatic link to HBV control.MethodsPatients who underwent HBV screening in the Ruijin Hospital from 2020 to 2021 were enrolled for the exposure rate estimation. Among antibody to HBV core antigen (HBcAb)-positive patients, we adopted propensity score matching (PSM) to study the impact of rheumatism on HBsAg seroprevalence after exposure. A second PSM evaluated the Ag/Ab differences. We also had HBsAg prevalence in human leukocyte antigen B2 (HLA-B27) tested patients studied.ResultsWith 33,989 screened patients, exposure rates remained comparable between rheumatic and non-rheumatic patients: 48.94 vs. 49.86%. PSM first yielded 2,618 balanced pairs. We observed significantly fewer patients with rheumatic diseases in HBsAg positive cases than negative ones (p < 0.001). In the second round, PSM matched 279 pairs, HBsAg (p < 0.001) and HBeAg (p < 0.05) positivity rates were significantly lower in the rheumatic patients, whereas HBsAb positivity rate (p < 0.001) and level (p < 0.01) were significantly higher. Though the value of HBcAb was overall significantly lower (p < 0.001) within the realm of rheumatic diseases, patients with ankylosing spondylitis (AS) demonstrated a significantly higher value than other rheumatic diseases. We saw significantly fewer HBV infections in HLA-B27 positive subjects than in the negative ones (p < 0.001).ConclusionIn this propensity score-matched study, rheumatic patients had an advantage in HBV control. In rheumatic patients, HBcAb levels, together with the beneficial role of HLA-B27, were highlighted.
Highlights
The WHO estimates 296 million people had chronic hepatitis B infection in 2019
We discovered that the HBcAb level possessed a prognostic value in severe cases (12), albeit in a biphasic manner
Ankylosing spondylitis (AS) was diagnosed according to the Assessment of SpondyloArthritis International Society/European League Against Rheumatism (ASAS-EULAR) recommendations (13), systemic lupus erythematosus (SLE) according to 2019 European Alliance of Associations for Rheumatology/American College of Rheumatology (EULAR/ACR) classification criteria (14), RA based on 2010 ACR/EULAR classification criteria (15), Sjögren’s syndrome (SS) based on 2016 ACR/EULAR criteria (16), dermatomyositis (DM) by using the classification criteria of 2017 EULAR/ACR (17), and vasculitis according to ACR/EULAR-endorsed diagnostic and classification criteria (18)
Summary
The WHO estimates 296 million people had chronic hepatitis B infection in 2019. Hepatitis B virus (HBV) can cause persistent infection, leading to cirrhosis and hepatocellular carcinoma (1). HBV, by evolving host mimicking strategies, causes inertia in host immunity. It is the possibility of a systemic rescue and it has been evidenced by the fact that CD8+ T cells dysfunction induced locally by hepatocellular priming can be counteracted in vivo by treatment with IL-2 (2). CD8+ T cells are considered the ultimate effectors of viral clearance. By determining the hepatitis B virus (HBV) surface antigen (HBsAg) positive rate postexposure and HBV-specific antigen/antibody (Ag/Ab) level in patients with rheumatic diseases, we aimed at exploring the rheumatic link to HBV control
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