İmmunsupresif Tedavi Alan Hastalarda HBV Reaktivasyonu ve Antiviral Profilaksinin Değerlendirilmesi

Amaç: Kronik hepatit B’li hastalar ve geçirilmiş hepatit B virüs enfeksiyonu olan kişiler immünsupresif tedavi aldıkları zaman HBV reaktivasyonu riskine maruz kalırlar. Bu çalışmada romatolojik hastalıklar nedeni ile çeşitli immünsupresif tedavileri alan hastaların hepatit B serolojilerini, risk gruplarını ve antiviral profilaksi alma durumlarını sunmayı amaçladık. Gereç ve Yöntem: Çalışmaya Mayıs 2022 ile Mayıs 2023 tarihleri arasında bir eğitim ve araştırma hastanesinde romatolojik hastalıklar nedeni ile tümör nekroz faktör-α inhibitörü, tirozin kinaz inhibitörü, steroid, metotreksat veya anti-CD20 antikoru alan 18 yaş üstü 375 hasta dahil edildi. Hastaların HbsAg, anti-Hbs ve anti-Hbc IgG serolojileri, immünsupresif tedavileri ve süresi ile almış oldukları oral antiviraller retrospektif olarak incelendi. Bulgular: Çalışmaya alınan 375 hastanın yaş ortalaması 43.77±13.07 idi. Hastaların 193’ ü (%51.5) erkek idi. Hastaların 11’ inde HbsAg pozitif, 150’ sinde anti Hbs pozitif, 19’ unda izole anti-Hbc IgG pozitif ve 79 hastada ise anti-Hbs ile anti-Hbc IgG beraber pozitif idi. Serolojik bulgulara göre 109 (%29) hastada HBV ile karşılaşma durumu mevcuttu. 194 (%51.7) hastanın ise her üç tetkik sonucu da negatif idi. Toplamda 85 (%22.7) hasta immünsupresif ajan kullanımı nedeni ile oral antiviral profilaksi almaktaydı. HBV reaktivasyon riski profilaksi başlanan hastaların 14’ ünde (%16.5) yüksek, 64’ ünde (%75.3) orta, 7’ sinde (%8.2) düşük riskliydi. 79 hasta entekavir, 5 hasta tenofovir disoproksil fumarat ve 1 hasta ise tenofovir alafenamid fumarat almakta idi. Ortalama immünsüpresif tedavi alma süresi 6.41±4.20 yıl idi. Hastaların oral antiviral profilaksi alma süreleri ise ortalama 1.02±1.72 yıl idi. HBV reaktivasyonu görülen hastamız olmadı. Sonuç: Hastalar immünsupresif tedavi almadan önce hepatit B serolojileri ve profilaksi durumları öncelikle değerlendirilmelidir. Ayrıca koruyucu hekimlik faaliyeti olarak aşısız hastaların en kısa sürede hepatit B aşıları tamamlanmalıdır.

Anahtar Kelimeler:

İmmünsupresyon, hepatit B, reaktivasyon

Evaluation of HBV Reactivation and Antiviral Prophylaxis in Patients Receiving Immunosuppressive Therapy

Aim: Patients with chronic hepatitis B and people with a history of hepatitis B (HBV) infection are at risk of HBV reactivation (HBVr) when they receive immunosuppressive therapy. In this study, we aimed to evaluate the hepatitis B serology, risk groups and antiviral prophylaxis of patients receiving various immunosuppressive therapies due to rheumatological diseases. Material and Method: The study included 375 patients over 18 years of age who received tumor necrosis factor-α (TNF-α) inhibitor, tyrosine kinase inhibitor, steroids, methotrexate or anti-CD20 antibodies due to rheumatic diseases in a training and research hospital between May 2022 and May 2023. Hepatitis B surface antigen (HbsAg), hepatitis B surface antibody (anti-Hbs), hepatitis B core protein antibody (anti-Hbc IgG) serologies, immunosuppressive therapies and oral antivirals were retrospectively analyzed. Results: The average age of the 375 patients included in the study was 43.77±13.07 years. 193 (51.5%) of the patients were male. 11 patients were HbsAg positive, 150 patients were anti-Hbs positive, 19 patients were isolated anti-Hbc IgG positive, and 79 patients were both anti-Hbs and anti-Hbc IgG positive. According to serological findings, 109 (29%) patients had HBV exposure. All three test results of 194 (51.7%) patients were negative. A total of 85 (22.7%) patients received oral antiviral prophylaxis due to the use of immunosuppressive agents. In terms of HBVr, 16.5% were evaluated as high risk, 75.3% as moderate risk, and 8.2% as low risk. Out of 85 patients 79 received entecavir, 5 reveived tenofovir disoproxil fumarate (TDF) and 1 received tenofovir alafenamide fumarate (TAF). The mean duration for the immunosuppressive therapy was 6.41±4.20 years. The mean duration of oral antiviral prophylaxis among patients was 1.02±1.72 years. HBVr was not observed in any of our patients. Conclusion: Before patients receive immunosuppressive therapy, hepatitis B serologies and prophylaxis indication should be evaluated firstly. In addition, as a preventive medicine activity, hepatitis B vaccinations of unvaccinated patients should be completed as quickly as possible.

Keywords:

Immunosuppression, hepatitis B, reactivation,

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