High Risk of Viral Reactivation in Hepatitis B Patients with Systemic Lupus Erythematosus
HBV reactivation (HBVr) can occur in hepatitis B surface antigen (HBsAg)-positive and negative patients. Here, we determined the incidence of HBVr and its related hepatitis in patients with systemic lupus erythematosus (SLE). From 2000 to 2017, 3307 SLE cases were retrospectively reviewed for episod...
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MDPI AG
2021-08-01
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| Series: | International Journal of Molecular Sciences |
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| Online Access: | https://www.mdpi.com/1422-0067/22/17/9116 |
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| author | Ming-Han Chen Chien-Sheng Wu Ming-Huang Chen Chang-Youh Tsai Fa-Yauh Lee Yi-Hsiang Huang |
| author_facet | Ming-Han Chen Chien-Sheng Wu Ming-Huang Chen Chang-Youh Tsai Fa-Yauh Lee Yi-Hsiang Huang |
| author_sort | Ming-Han Chen |
| collection | DOAJ |
| description | HBV reactivation (HBVr) can occur in hepatitis B surface antigen (HBsAg)-positive and negative patients. Here, we determined the incidence of HBVr and its related hepatitis in patients with systemic lupus erythematosus (SLE). From 2000 to 2017, 3307 SLE cases were retrospectively reviewed for episodes of hepatitis. The incidence, long-term outcomes and risk factors associated with HBVr, including HBsAg reverse seroconversion (RS) were analyzed. Among them, 607 had available HBsAg status. Fifty-five (9.1%) patients were positive for HBsAg and 63 (11.4%) were HBsAg-negative/antibody to hepatitis B core antigen (anti-HBc)-positive (resolved hepatitis B infection, RHB). None of them received antiviral prophylaxis before immunosuppressive treatment. During a mean 15.4 years of follow-up, 30 (54.5%) HBsAg-positive patients developed HBVr and seven (23.3%) died of liver failure, whereas only two (3.2%) RHB cases experienced HBsAg reverse seroconversion (RS). Multivariate logistic regression analysis showed that age ≥ 40 years at diagnosis of SLE (HR 5.30, <i>p</i> < 0.001), receiving glucocorticoid-containing immunosuppressive therapy (HR 4.78, <i>p</i> = 0.003), and receiving glucocorticoid ≥ 10 mg prednisolone equivalents (HR 3.68, <i>p</i> = 0.003) were independent risk factors for HBVr in HBsAg-positive patients. Peak level of total bilirubin ≥ 5 mg/dL during HBVr was an independent factor of mortality (<i>p</i> = 0.002). In conclusion, the risk of HBVr was associated with glucocorticoid daily dose. Antiviral prophylaxis is mandatory for SLE patients diagnosed at age of ≥40 years who receive ≥ 10 mg daily dose of oral prednisone or equivalent. |
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| language | English |
| last_indexed | 2024-03-10T08:11:44Z |
| publishDate | 2021-08-01 |
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| series | International Journal of Molecular Sciences |
| spelling | doaj.art-81a568adb76145f2895daf1951e7b1b02023-11-22T10:38:18ZengMDPI AGInternational Journal of Molecular Sciences1661-65961422-00672021-08-012217911610.3390/ijms22179116High Risk of Viral Reactivation in Hepatitis B Patients with Systemic Lupus ErythematosusMing-Han Chen0Chien-Sheng Wu1Ming-Huang Chen2Chang-Youh Tsai3Fa-Yauh Lee4Yi-Hsiang Huang5Division of Allergy-Immunology-Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, TaiwanDivision of Allergy-Immunology-Rheumatology, Department of Medicine, Far Eastern Memorial Hospital, Taipei 220216, TaiwanFaculty of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, TaiwanDivision of Allergy-Immunology-Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, TaiwanDivision of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, TaiwanDivision of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, TaiwanHBV reactivation (HBVr) can occur in hepatitis B surface antigen (HBsAg)-positive and negative patients. Here, we determined the incidence of HBVr and its related hepatitis in patients with systemic lupus erythematosus (SLE). From 2000 to 2017, 3307 SLE cases were retrospectively reviewed for episodes of hepatitis. The incidence, long-term outcomes and risk factors associated with HBVr, including HBsAg reverse seroconversion (RS) were analyzed. Among them, 607 had available HBsAg status. Fifty-five (9.1%) patients were positive for HBsAg and 63 (11.4%) were HBsAg-negative/antibody to hepatitis B core antigen (anti-HBc)-positive (resolved hepatitis B infection, RHB). None of them received antiviral prophylaxis before immunosuppressive treatment. During a mean 15.4 years of follow-up, 30 (54.5%) HBsAg-positive patients developed HBVr and seven (23.3%) died of liver failure, whereas only two (3.2%) RHB cases experienced HBsAg reverse seroconversion (RS). Multivariate logistic regression analysis showed that age ≥ 40 years at diagnosis of SLE (HR 5.30, <i>p</i> < 0.001), receiving glucocorticoid-containing immunosuppressive therapy (HR 4.78, <i>p</i> = 0.003), and receiving glucocorticoid ≥ 10 mg prednisolone equivalents (HR 3.68, <i>p</i> = 0.003) were independent risk factors for HBVr in HBsAg-positive patients. Peak level of total bilirubin ≥ 5 mg/dL during HBVr was an independent factor of mortality (<i>p</i> = 0.002). In conclusion, the risk of HBVr was associated with glucocorticoid daily dose. Antiviral prophylaxis is mandatory for SLE patients diagnosed at age of ≥40 years who receive ≥ 10 mg daily dose of oral prednisone or equivalent.https://www.mdpi.com/1422-0067/22/17/9116systemic lupus erythematosusHBV reactivationimmunosuppressive therapyHBV carrierresolved hepatitis B |
| spellingShingle | Ming-Han Chen Chien-Sheng Wu Ming-Huang Chen Chang-Youh Tsai Fa-Yauh Lee Yi-Hsiang Huang High Risk of Viral Reactivation in Hepatitis B Patients with Systemic Lupus Erythematosus International Journal of Molecular Sciences systemic lupus erythematosus HBV reactivation immunosuppressive therapy HBV carrier resolved hepatitis B |
| title | High Risk of Viral Reactivation in Hepatitis B Patients with Systemic Lupus Erythematosus |
| title_full | High Risk of Viral Reactivation in Hepatitis B Patients with Systemic Lupus Erythematosus |
| title_fullStr | High Risk of Viral Reactivation in Hepatitis B Patients with Systemic Lupus Erythematosus |
| title_full_unstemmed | High Risk of Viral Reactivation in Hepatitis B Patients with Systemic Lupus Erythematosus |
| title_short | High Risk of Viral Reactivation in Hepatitis B Patients with Systemic Lupus Erythematosus |
| title_sort | high risk of viral reactivation in hepatitis b patients with systemic lupus erythematosus |
| topic | systemic lupus erythematosus HBV reactivation immunosuppressive therapy HBV carrier resolved hepatitis B |
| url | https://www.mdpi.com/1422-0067/22/17/9116 |
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