ANTI-TNF-ALFA AGENTS TREATMENT AMONG PATIENTS PREVIOUSLY INFECTED WITH HEPATITIS B VIRUS – ARE THESE PATIENTS IN RISK?
Autor(a) principal: | |
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Data de Publicação: | 2013 |
Outros Autores: | , |
Tipo de documento: | Artigo |
Idioma: | por |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | https://doi.org/10.29021/spdv.70.1.37 |
Resumo: | It is estimated that 2 billion people worldwide have been infected with the hepatitis B virus (HBV) and over 350 million are chronic carriers. Patients who present antibodies to hepatitis B core antigen (anti-HBc) with con- current HBsAg negativity do not have chronic hepatitis, but only experienced HBV infection and were able to clear it. Nevertheless, some of these patients may be occult carriers, in whom intrahepatic HBV replication can be detected. HBV reactivation is a commonly reported complication in patients undergoing chemotherapy for malignancies and in patients after bone marrow transplantation. Reactivation largely occurs in patients with chronic hepatitis B who are positive for HBsAg, but it can also affect previously infected patients who have apparently cleared the virus. The HBV reactivation risk in patients with chronic hepatitis B (HBsAg +) undergoing anti-TNF-α therapy is also well established, however, information regarding the use of these drugs in patients Ac anti-HBc + / HBsAg- is more scarce. Recently, it has been reported a 5% HBV reactivation rate in patients Ac anti-HBc + / HBsAg- treated with anti-TNF-α agents, showing that this risk is real. Since 2010, all patients of the Department of Dermatology at the Centro Hospitalar do Porto – Hospital de Santo António (CHP-HSA) that initiate biological treatment for psoriasis / psoriatic arthritis and are positive for anti-HBc are also consulted in the Hepatology Clinic in order to establish the existence of chronic liver disease, and if there is an indication for early anti-viral prophylactic therapy. The authors aim to highlight the need for mandatory screening of HBV in all patients who will initiate biological therapy with TNF-α inhibitors, relatively consensual in the scientific community, but especially the need for vigilance and close monitoring of patients with potential occult HBV infection due to the possible risk of HBV reactivation.KEYWORDS – Hepatitis B; Hepatitis B Surface Antigens; Tumor Necrosis Factor-alpha; Hepatitis B Core Antigens. |
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ANTI-TNF-ALFA AGENTS TREATMENT AMONG PATIENTS PREVIOUSLY INFECTED WITH HEPATITIS B VIRUS – ARE THESE PATIENTS IN RISK?TRATAMENTO COM INIBIDORES DO TNF-ALFA EM DOENTES COM INFECÇÃO PRÉVIA POR VÍRUS DA HEPATITE B – ESTARÃO ESTES DOENTES EM RISCO DE REACTIVAR A DOENÇA?It is estimated that 2 billion people worldwide have been infected with the hepatitis B virus (HBV) and over 350 million are chronic carriers. Patients who present antibodies to hepatitis B core antigen (anti-HBc) with con- current HBsAg negativity do not have chronic hepatitis, but only experienced HBV infection and were able to clear it. Nevertheless, some of these patients may be occult carriers, in whom intrahepatic HBV replication can be detected. HBV reactivation is a commonly reported complication in patients undergoing chemotherapy for malignancies and in patients after bone marrow transplantation. Reactivation largely occurs in patients with chronic hepatitis B who are positive for HBsAg, but it can also affect previously infected patients who have apparently cleared the virus. The HBV reactivation risk in patients with chronic hepatitis B (HBsAg +) undergoing anti-TNF-α therapy is also well established, however, information regarding the use of these drugs in patients Ac anti-HBc + / HBsAg- is more scarce. Recently, it has been reported a 5% HBV reactivation rate in patients Ac anti-HBc + / HBsAg- treated with anti-TNF-α agents, showing that this risk is real. Since 2010, all patients of the Department of Dermatology at the Centro Hospitalar do Porto – Hospital de Santo António (CHP-HSA) that initiate biological treatment for psoriasis / psoriatic arthritis and are positive for anti-HBc are also consulted in the Hepatology Clinic in order to establish the existence of chronic liver disease, and if there is an indication for early anti-viral prophylactic therapy. The authors aim to highlight the need for mandatory screening of HBV in all patients who will initiate biological therapy with TNF-α inhibitors, relatively consensual in the scientific community, but especially the need for vigilance and close monitoring of patients with potential occult HBV infection due to the possible risk of HBV reactivation.KEYWORDS – Hepatitis B; Hepatitis B Surface Antigens; Tumor Necrosis Factor-alpha; Hepatitis B Core Antigens.Estima-se que cerca de 2 mil milhões de pessoas estejam infectados pelo vírus da hepatite B (VHB) e que mais de 350 milhões sejam portadores crónicos. Os doentes que apresentam anticorpos para o antigénio core (Ac anti-HBc) com negatividade para antigénio de superfície (AgHBs), não têm hepatite crónica, mas contactaram com o vírus no passado. Este estado serológico corresponde, na maioria das vezes, a uma eliminação vírica completa. Contudo, um subgrupo de doentes poderá apresentar ADN-VHB hepático detectável, definindo um estado de por- tador oculto. A reactivação do VHB é uma complicação descrita desde há vários anos em doentes submetidos a transplantes de medula óssea e quimioterapia para tratamento de neoplasias. Esta reactivação ocorre principalmente em doentes com hepatite B crónica (AgHBs+), mas foi igualmente descrita em doentes previamente infectados pelo VHB, que aparentemente teriam eliminado o vírus. Este risco de reactivação da replicação do VHB em doentes com hepatite B crónica (AgHBs+) submetidos a terapêutica anti-TNF-α está igualmente bem estabelecido, contudo, a informa- ção relativamente ao uso destes fármacos em doentes Ac anti-HBc+/AgHBS- é muito mais escassa. Recentemente, identificou-se uma taxa de reactivação do VHB em doentes Ac anti-HBc+/AgHBs- tratados com agentes anti-TNF-α de 5%, demonstrando que, apesar de baixo, este risco é real. Desde o final de 2010 que todos os doentes do Serviço de Dermatologia do Centro Hospitalar do Porto – Hospital de Santo António (CHP-HSA) que iniciam terapêutica biológica para o tratamento de psoríase/artrite psoriática e que apresentam positividade para o Ac anti-HBc são também observados em consulta de Medicina Interna/Hepatologia do CHP-HSA no sentido de estabelecer da existência de doença hepática crónica, e de verificar se existe indicação para o início de terapêutica profilática anti-viral. Com este artigo, os autores pretendem alertar para a necessidade de rastreio obrigatório do VHB em todos os do- entes que vão iniciar terapêutica biológica com inibidores TNF-α, situação relativamente consensual na comunidade científica, mas especialmente para a necessidade de vigilância e monitorização apertada dos doentes com potencial infecção oculta pelo VHB, pelo risco possível de reactivação do mesmo.PALAVRAS-CHAVE – Hepatite B; Inibidores do TNF-α; Ac anti-HBc; AgHBs.Sociedade Portuguesa de Dermatologia e Venereologia2013-01-20T00:00:00Zjournal articleinfo:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://doi.org/10.29021/spdv.70.1.37oai:ojs.revista.spdv.com.pt:article/37Journal of the Portuguese Society of Dermatology and Venereology; Vol 70 No 1 (2012): Janeiro - Março; 47Revista da Sociedade Portuguesa de Dermatologia e Venereologia; v. 70 n. 1 (2012): Janeiro - Março; 472182-24092182-2395reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPporhttps://revista.spdv.com.pt/index.php/spdv/article/view/37https://doi.org/10.29021/spdv.70.1.37https://revista.spdv.com.pt/index.php/spdv/article/view/37/38Torres, TiagoNery, FilipeSelores, Manuelainfo:eu-repo/semantics/openAccess2022-10-06T12:34:36Zoai:ojs.revista.spdv.com.pt:article/37Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T16:10:38.446459Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
ANTI-TNF-ALFA AGENTS TREATMENT AMONG PATIENTS PREVIOUSLY INFECTED WITH HEPATITIS B VIRUS – ARE THESE PATIENTS IN RISK? TRATAMENTO COM INIBIDORES DO TNF-ALFA EM DOENTES COM INFECÇÃO PRÉVIA POR VÍRUS DA HEPATITE B – ESTARÃO ESTES DOENTES EM RISCO DE REACTIVAR A DOENÇA? |
title |
ANTI-TNF-ALFA AGENTS TREATMENT AMONG PATIENTS PREVIOUSLY INFECTED WITH HEPATITIS B VIRUS – ARE THESE PATIENTS IN RISK? |
spellingShingle |
ANTI-TNF-ALFA AGENTS TREATMENT AMONG PATIENTS PREVIOUSLY INFECTED WITH HEPATITIS B VIRUS – ARE THESE PATIENTS IN RISK? Torres, Tiago |
title_short |
ANTI-TNF-ALFA AGENTS TREATMENT AMONG PATIENTS PREVIOUSLY INFECTED WITH HEPATITIS B VIRUS – ARE THESE PATIENTS IN RISK? |
title_full |
ANTI-TNF-ALFA AGENTS TREATMENT AMONG PATIENTS PREVIOUSLY INFECTED WITH HEPATITIS B VIRUS – ARE THESE PATIENTS IN RISK? |
title_fullStr |
ANTI-TNF-ALFA AGENTS TREATMENT AMONG PATIENTS PREVIOUSLY INFECTED WITH HEPATITIS B VIRUS – ARE THESE PATIENTS IN RISK? |
title_full_unstemmed |
ANTI-TNF-ALFA AGENTS TREATMENT AMONG PATIENTS PREVIOUSLY INFECTED WITH HEPATITIS B VIRUS – ARE THESE PATIENTS IN RISK? |
title_sort |
ANTI-TNF-ALFA AGENTS TREATMENT AMONG PATIENTS PREVIOUSLY INFECTED WITH HEPATITIS B VIRUS – ARE THESE PATIENTS IN RISK? |
author |
Torres, Tiago |
author_facet |
Torres, Tiago Nery, Filipe Selores, Manuela |
author_role |
author |
author2 |
Nery, Filipe Selores, Manuela |
author2_role |
author author |
dc.contributor.author.fl_str_mv |
Torres, Tiago Nery, Filipe Selores, Manuela |
description |
It is estimated that 2 billion people worldwide have been infected with the hepatitis B virus (HBV) and over 350 million are chronic carriers. Patients who present antibodies to hepatitis B core antigen (anti-HBc) with con- current HBsAg negativity do not have chronic hepatitis, but only experienced HBV infection and were able to clear it. Nevertheless, some of these patients may be occult carriers, in whom intrahepatic HBV replication can be detected. HBV reactivation is a commonly reported complication in patients undergoing chemotherapy for malignancies and in patients after bone marrow transplantation. Reactivation largely occurs in patients with chronic hepatitis B who are positive for HBsAg, but it can also affect previously infected patients who have apparently cleared the virus. The HBV reactivation risk in patients with chronic hepatitis B (HBsAg +) undergoing anti-TNF-α therapy is also well established, however, information regarding the use of these drugs in patients Ac anti-HBc + / HBsAg- is more scarce. Recently, it has been reported a 5% HBV reactivation rate in patients Ac anti-HBc + / HBsAg- treated with anti-TNF-α agents, showing that this risk is real. Since 2010, all patients of the Department of Dermatology at the Centro Hospitalar do Porto – Hospital de Santo António (CHP-HSA) that initiate biological treatment for psoriasis / psoriatic arthritis and are positive for anti-HBc are also consulted in the Hepatology Clinic in order to establish the existence of chronic liver disease, and if there is an indication for early anti-viral prophylactic therapy. The authors aim to highlight the need for mandatory screening of HBV in all patients who will initiate biological therapy with TNF-α inhibitors, relatively consensual in the scientific community, but especially the need for vigilance and close monitoring of patients with potential occult HBV infection due to the possible risk of HBV reactivation.KEYWORDS – Hepatitis B; Hepatitis B Surface Antigens; Tumor Necrosis Factor-alpha; Hepatitis B Core Antigens. |
publishDate |
2013 |
dc.date.none.fl_str_mv |
2013-01-20T00:00:00Z |
dc.type.driver.fl_str_mv |
journal article info:eu-repo/semantics/article |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
https://doi.org/10.29021/spdv.70.1.37 oai:ojs.revista.spdv.com.pt:article/37 |
url |
https://doi.org/10.29021/spdv.70.1.37 |
identifier_str_mv |
oai:ojs.revista.spdv.com.pt:article/37 |
dc.language.iso.fl_str_mv |
por |
language |
por |
dc.relation.none.fl_str_mv |
https://revista.spdv.com.pt/index.php/spdv/article/view/37 https://doi.org/10.29021/spdv.70.1.37 https://revista.spdv.com.pt/index.php/spdv/article/view/37/38 |
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info:eu-repo/semantics/openAccess |
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openAccess |
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application/pdf |
dc.publisher.none.fl_str_mv |
Sociedade Portuguesa de Dermatologia e Venereologia |
publisher.none.fl_str_mv |
Sociedade Portuguesa de Dermatologia e Venereologia |
dc.source.none.fl_str_mv |
Journal of the Portuguese Society of Dermatology and Venereology; Vol 70 No 1 (2012): Janeiro - Março; 47 Revista da Sociedade Portuguesa de Dermatologia e Venereologia; v. 70 n. 1 (2012): Janeiro - Março; 47 2182-2409 2182-2395 reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
instname_str |
Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
instacron_str |
RCAAP |
institution |
RCAAP |
reponame_str |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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