Safety of tumor necrosis factor α blockers in hepatitis B virus occult carriers (hepatitis B surface antigen negative/anti–hepatitis B core antigen positive) with rheumatic diseases

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Abstract
Objective To assess the safety of anti–tumor necrosis factor α (anti‐TNFα) therapy on the course of hepatitis B virus (HBV) infection in carriers of antibodies to hepatitis B core antigen (anti‐HBc) affected by chronic inflammatory arthropathies. Methods From January 2001 to December 2008, HBV markers were determined before the first administration of anti‐TNFα agents in all 732 patients affected by inflammatory arthropathies treated with anti‐TNFα at 2 outpatient rheumatologic clinics in Northern Italy. Anti‐HBc–positive patients were prospectively evaluated and HBV markers and HBV DNA were assessed every 6 months, in case of aminotransferase elevation, and at the end of the study. Results At the time of recruitment, 72 patients were anti‐HBc carriers, 5 of whom were positive for hepatitis B surface antigen (HBsAg) and not included in the study. The ratio of men:women was 26:41 and the mean ± SD followup was 42.52 ± 21.33 months. Of the patients, 25 were treated with infliximab, 23 with etanercept, and 19 with adalimumab. Fifty‐one patients were treated also with methotrexate, 52 with nonsteroidal antiinflammatory drugs, and 43 with prednisone (3 with a dosage >7.5 mg/day). All anti‐HBc patients were HBV DNA negative at the first observation. During followup, no patient presented HBV reactivation with viral load increase and no patient became HBsAg positive. Conclusion Anti‐HBc positivity in HBsAg‐negative patients is a sign of previous HBV infection and does not indicate chronic hepatitis. In these patients, anti‐TNFα therapy appears to be quite safe, as no HBV reactivation was found in our study. Nevertheless, careful monitoring is necessary.

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