Published online Mar 27, 2015. doi: 10.4254/wjh.v7.i3.344
Peer-review started: September 9, 2014
First decision: October 14, 2014
Revised: November 25, 2014
Accepted: December 16, 2014
Article in press: December 16, 2014
Published online: March 27, 2015
Hepatitis B virus (HBV) reactivation in rheumatoid arthritis (RA) patients undergoing biological therapy is not infrequent. This condition can occur in patients with chronic hepatitis B as well as in patients with resolved HBV infection. Current recommendations are mainly focused on prevention and management strategies of viral reactivation under tumor necrosis factor-α inhibitors or chimeric monoclonal antibody rituximab. In recent years, growing data concerning HBV reactivation in RA patients treated with newer biological drugs like tocilizumab and abatacept have cumulated. In this review, epidemiology, pathogenesis and natural history of HBV infection have been revised first, mainly focusing on the role that specific therapeutic targets of current biotechnological drugs play in HBV pathobiology; finally we have summarized current evidences from scientific literature, including either observational studies and case reports as well, concerning HBV reactivation under different classes of biological drugs in RA patients. Taking all these evidences into account, some practical guidelines for screening, vaccination, prophylaxis and treatment of HBV reactivation have been proposed.
Core tip: Hepatitis B virus (HBV) infection represents a major issue in patients with rheumatoid arthritis (RA) undergoing biological disease-modifying anti-rheumatic drugs (bDMARDs). While several observational studies and trials deal with the risk of HBV reactivation under anti-TNF agents, there is limited experience with newer drugs as tocilizumab (TCZ) and abatacept (ABA). In this paper, literature concerning the risk of HBV reactivation in RA patients undergoing different classes of bDMARDs, including ABA and TCZ, has been revised. Finally, some evidence-based practical suggestions for the management of this condition are proposed.