Do low titers of antibody against hepatitis B surface antigen carry a risk of viral reactivation during immunosuppressive therapy for rheumatic diseases?

摘要

I read with great interest the article by Kato, et al regarding hepatitis B virus (HBV) reactivation in patients receiving immunosuppressive therapy for autoimmune diseases1. The authors had performed a foliowup study on 35 patients who were negative for hepatitis B surface antigen (HBsAg) and positive for antibody against hepatitis B core antigen (anti-HBc). During the 8- to 124-week period of followup, 6 patients (17%) experienced reactivation of viral replication. The authors showed that baseline titers of antibody against HBsAg (anti-HBs) were significantly lower in these patients than in the others (median 2.83 mlU/ml, range 0.24-168.5 vs median 99.9 mlU/ml, range 0.00-5343; p = 0.036). Accordingly, they suggested that low baseline anti-HBs titers may be a risk factor for viral reactivation in this clinical setting. Among the 6 patients with viral reactivation, however, 1 had a relatively high titer of serum anti-HBs at baseline (168.5 mlU/ml).