VIRAL B AND C HEPATITIS IN RHEUMATIC PATIENTS UNDER BIOLOGICAL THERAPY
Abstract
Both rheumatic immune-inflammatory diseases and viral hepatitis represent important health problems worldwide. Modern therapies with biological and targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) have revolutionized the management of immune-inflammatory diseases. However, these therapies have a strong immunosuppressive impact, patients being at risk of reactivation of viral hepatitis. The aim of this study was to assess the prevalence and the risk of reactivation of B and C hepatitis (HBV, HCV) in rheumatic patients who are treated with b/tsDMARDs for rheumatoid arthritis (RA) and ankylosing spondylitis (AS). Material and methods: We retrospectively analyzed all patients with RA and AS receiving b/tsDMARDs therapies in the Rheumatology department over a one-year period. Serological screening for HBV infection (HBsAg, anti-HBc, anti-HBs) and HCV antibodies was performed in all patients. For each patient we reviewed the diagnosis, demographic data, type of the treatment, HBV and HCV serology, viral infection treatment. Results: There were 132 patients diagnosed with RA and 90 patients diagnosed with AS receiving therapy with bDMARDs or tsDMARDs. 65 of the patients with RA (49.24%) and 32 of those with AS (35.55%) presented changes in viral markers. Both in the group of patients with RA and those with AS, approximately 10% of patients showed previous B vaccination. Only 2.27% of the patients with RA and 1.11% of those with AS presented chronic B infection. Most of the patients (36.36% RA, 24.44% AS) had resolved B infection. Inactive HCV infection was found in 2.25% of total number of patients. A percentage of 12.12% among those with RA and 3.33% of those with AS received treatment with Entecavir/Tenofovir. There were no cases of hepatitis reactivation. Conclusions: Viral B infection has a high prevalence in patients with RA and AS. Screening for chronic viral B and C infections should be done in all patients with autoimmune rheumatic diseases. Treatment with nucleotide/nucleoside analogs is effective in preventing HBV flare regardless of the type of b/tsDMARDs. All patients with viral C infection should be treated with direct-acting antivirals.
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