Anti-TNF alfa kullanan hastalarda hepatit B reaktivasyonunun değerlendirilmesi

Amaç: Anti-tümör nekrozis faktör alfa (anti-TNF) alfa kullanan HBsAg pozitif hastalarda profilaksi önerilmektedir. HbsAg (-), anti-HBcIgG ( +/-) ve anti-HBsIgG (-)hastalarda ise hepatit B profilaksisi tartışmalıdır. Bu çalışmada antiTNF alfa kullanan hastalarda HBV tarama oranı ve reaktivasyon sıklığının saptanması amaçlanmıştır. Yönetmler: Çalışma tek merkezde retrospektif olarak yürütülmüştür. Farklı endikasyonlarla anti-TNF alfa kullanan hastalarda tedavi öncesi hepatit B göstergeleri (HBsAg, anti-HBcIgG, anti-HBs) ile viral yük tetkik sonuçları elektronik dosya kayıtlarından taranmıştır. Bulgular: Farklı endikasyonlarla anti-TNF alfa kullanan 644 hasta çalışmaya alınmıştır. Bu hastaların 410’u (%63,7) tedavi öncesinde hepatit B açısından taranmıştır. (410 hastanın 17’si HBsAg (+) (grup 1), 39’u HBsAg (-), anti-HBs(+) ve anti-HBcIgG (+) (grup 2), 15’i izole anti-HBcIgG (+) (grup 3), 339‘u viral göstergeleri negatif (grup 4) olarak saptanmıştır). Hastalar ortalama 28 ay süreyle takip edilmiştir. Grup 1 hastaların 13’ü (%76), grup 2 ve 3’deki hastaların ise 48’i (%88,9) reaktivasyon açısından takip edilmiştir. Grup 2 ve 3’deki hastaların hiçbirisinde takiplerinde HBV reaktivasyonu gelişmezken, grup 1 hastalarının birinde reaktivasyon gelişmiştir. Anti-TNF öncesinde tarama yapılmayan bir hastada da reaktivasyon tespit edilmiştir. Sonuç: Anti-TNF alfa alan hastaların reaktivasyon açısından tarama ve takibinin doğru zamanda ve uygun testlerle yapılması ve hastaların yakın izlemi gerekmektedir.

Evaluation of hepatitis B reactivation in patients receiving anti-TNF alpha

Objective: Prophylaxis is recommended in HBsAg positive patients receiving anti-TNF alpha. HBV prophylaxis is controversial in HbsAg (-), anti-HBc IgG (+) and anti-HBs IgG (+/-) patients. The aim of this study was to determine HBV screening rate and reactivation frequency in patients receiving anti-TNF alpha. Methods: The study was conducted retrospectively in a single center. Hepatitis B markers (HBsAg, anti-HBcIgG, antiHBs) and viral load results were screened from electronic file records in patients who were treated with anti-TNF alpha for different indications. Results: Sixty-four patients using anti-TNF alpha for different indications were included in the study. 410 (63.7%) of these patients were screened for hepatitis B before treatment. (Of the 410 patients, 17 were HBsAg (+) (group 1), 39 were HBsAg (-), anti-HBs(+) and anti-HBc IgG (+) (group 2), 15 isolated anti-HBc IgG (+) (group 3), 339 were marker negative (group 4). Patients were followed for a mean of 28 months. 13 (76%) of the patients in group 1 and 48 (88.9%) of the patients in group 2 and 3 were followed for reactivation. None of the patients in group 2 and 3 developed HBV reactivation during follow-up, while one of the patients from group 1 developed reactivation. Reactivation was also detected in one patient who had not been screened prior to anti-TNF therapy. Conclusion: Screening and follow-up of patients receiving anti-TNF alpha in terms of reactivation should be performed at the right time with appropriate tests and close monitoring of the patients is required.

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