Regarding the problem of viral hepatitis reactivation in rheumatic diseases: risks and curation issues

Abstract

Infection caused by hepatitis B virus (HBV) remains an important global public health problem with high morbidity and mortality. In modern rheumatology the problem of HBV as a comorbid infection deserves undoubted attention, especially in immune inflammatory rheumatic diseases (IIRD). This fact makes it necessary to modify the treatment tactics of patients receiving modern antirheumatic therapy, including basic anti-inflammatory (BAID) and genetically engineered biological drugs (GEBD). Given the expected further increase in the use of GEBD and new oral targeted BAID (Janus kinase inhibitors) in the treatment of rheumatic diseases, rheumatologists should be aware of the potential risk, recommendations for screening and opportunities for prevention and monitoring of HBV-reactivation (HBV-r). Most of the literature on HBV-r has been obtained from haematology and oncology, which uses combinations of drugs with higher immunosuppressive potential, usually for a short period of time (months). This data should be interpreted with caution in regard to rheumatic diseases, where immunosuppression intensity is lower and therapy duration is longer (several years). In recent years, an attempt has been made to stratify the HBV-r risk according to the patient’s serological status and the type and duration of immunosuppressive treatment used. Based on the above factors, the American Gastroenterological Association has classified the risk of HBV-r as low (<1%), moderate (1-10%) and high (>10%). However, appearance of new drugs and longer duration of their use in rheumatic diseases, wherethere are usually no established timeframes for discontinuation of treatment, require additional explanation of the recommendations on the curation and monitoring of HBV-r. This article presents modern data on HBV-r risk in patients with HBV during treatment with various BAID and GEBD, emphasizes the importance of screening examination for HBV-infection before the planned immunosuppressive therapy and highlights issues related to the tactics of prescribing antiviral prophylaxis and monitoring of these patients condition.

Keywords

• rheumatic diseases
• immunosuppressive therapy
• chronic viral hepatitis b
• reactivation
• prophylaxis