Lack of hepatitis B virus reactivation after anti-tumour necrosis factor treatment in potential occult carriers with chronic inflammatory arthropathies

Background: Hepatitis B virus (HBV) reactivation in patients positive for antibody to HB core antigen (anti-HBc), negative for HB surface antigen (HBsAg) and HBV-DNA (potential occult HBV carriers), treated with anti-tumor necrosis factor (TNF)alpha, is a debated question. The aim of the study was to evaluate the safety of anti-TNF alpha therapy in anti-HBc positive/HBsAg negative subjects with rheumatoid arthritis (RA) and spondyloarthropathy (SpA). Methods: All consecutive HBsAg negative RA and SpA outpatients referring to the Immuno-Rheumatology Institute at the S. Andrea hospital, Sapienza, University of Rome who had to undergo anti-TNF alpha therapy. Results: Among the 169 enrolled subjects, 20 (12%) were potential occult HBV carriers (anti-HBc positive, HBsAg and HBV-DNA negative patients with or without anti-HBs). During the follow-up (mean +/- SD 45 +/- 22 months), aminotransferases and HBV-DNA, tested every two and six months respectively, did not change. Conclusion: This study confirms the substantial safety of anti-TNF alpha therapy in potential occult HBV carriers RA and SpA patients. (C) 2014 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.