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Article: Management of hepatitis B reactivation in patients with lupus nephritis

TitleManagement of hepatitis B reactivation in patients with lupus nephritis
Authors
Issue Date2009
PublisherSpringer Verlag. The Journal's web site is located at http://link.springer.de/link/service/journals/00296/index.htm
Citation
Rheumatology International, 2009, v. 29 n. 11, p. 1273-1277 How to Cite?
AbstractHepatitis B is endemic in many Asian countries and immunosuppression may precipitate hepatitic flare. There is little data on the treatment of hepatitis B in patients with systemic lupus erythematosus. We monitored serial transaminase and HBV DNA levels in our HBsAg-positive patients with a history of lupus nephritis and instituted anti-viral treatment in patients who showed virological reactivation. This retrospective pilot study reports the data with this pre-emptive management strategy. Amongst 228 patients with lupus nephritis, eight (3.51%) were HBsAg-positive and five had received Lamivudine treatment for hepatitis B. In two patients the virological flares were preceded by lupus flares that necessitated an increase in immunosuppressive treatment. Median HBV DNA level was 1.9 × 107 copies/mL (range 1.2 × 10 4-1.0 × 109 copies/mL) at baseline, and it decreased by 2-5 logs after treatment. Four patients had abnormal transaminase levels at baseline, with mean alanine aminotransferase at 125.0 ± 67.4 U/L, and all achieved normalisation after 3-24 months (median 13 months) of treatment. Discontinuation of Lamivudine treatment was attempted in three patients after 9-15 months. In one patient treatment was recommenced because of virological flare. For the remaining two patients in whom treatment was not interrupted, one showed sustained viral suppression and one developed drug resistance. All antiviral treatments were well-tolerated. These results indicate the importance of serial monitoring of HBV DNA and transaminase levels, and prompt anti-viral therapy, in the management of HBsAg-positive lupus patients. Also, it may be feasible to discontinue treatment in stable patients to avoid the selection of drug-resistant variants. © 2009 Springer-Verlag.
Persistent Identifierhttp://hdl.handle.net/10722/163266
ISSN
2015 Impact Factor: 1.702
2015 SCImago Journal Rankings: 0.638
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorTse, KCen_US
dc.contributor.authorYung, Sen_US
dc.contributor.authorTang, Cen_US
dc.contributor.authorYip, TPSen_US
dc.contributor.authorChan, TMen_US
dc.date.accessioned2012-09-05T05:29:21Z-
dc.date.available2012-09-05T05:29:21Z-
dc.date.issued2009en_US
dc.identifier.citationRheumatology International, 2009, v. 29 n. 11, p. 1273-1277en_US
dc.identifier.issn0172-8172en_US
dc.identifier.urihttp://hdl.handle.net/10722/163266-
dc.description.abstractHepatitis B is endemic in many Asian countries and immunosuppression may precipitate hepatitic flare. There is little data on the treatment of hepatitis B in patients with systemic lupus erythematosus. We monitored serial transaminase and HBV DNA levels in our HBsAg-positive patients with a history of lupus nephritis and instituted anti-viral treatment in patients who showed virological reactivation. This retrospective pilot study reports the data with this pre-emptive management strategy. Amongst 228 patients with lupus nephritis, eight (3.51%) were HBsAg-positive and five had received Lamivudine treatment for hepatitis B. In two patients the virological flares were preceded by lupus flares that necessitated an increase in immunosuppressive treatment. Median HBV DNA level was 1.9 × 107 copies/mL (range 1.2 × 10 4-1.0 × 109 copies/mL) at baseline, and it decreased by 2-5 logs after treatment. Four patients had abnormal transaminase levels at baseline, with mean alanine aminotransferase at 125.0 ± 67.4 U/L, and all achieved normalisation after 3-24 months (median 13 months) of treatment. Discontinuation of Lamivudine treatment was attempted in three patients after 9-15 months. In one patient treatment was recommenced because of virological flare. For the remaining two patients in whom treatment was not interrupted, one showed sustained viral suppression and one developed drug resistance. All antiviral treatments were well-tolerated. These results indicate the importance of serial monitoring of HBV DNA and transaminase levels, and prompt anti-viral therapy, in the management of HBsAg-positive lupus patients. Also, it may be feasible to discontinue treatment in stable patients to avoid the selection of drug-resistant variants. © 2009 Springer-Verlag.en_US
dc.languageengen_US
dc.publisherSpringer Verlag. The Journal's web site is located at http://link.springer.de/link/service/journals/00296/index.htmen_US
dc.relation.ispartofRheumatology Internationalen_US
dc.subject.meshAdulten_US
dc.subject.meshAlanine Transaminase - Blooden_US
dc.subject.meshAntiviral Agents - Therapeutic Useen_US
dc.subject.meshDna, Viral - Blooden_US
dc.subject.meshFemaleen_US
dc.subject.meshHepatitis B - Drug Therapy - Epidemiologyen_US
dc.subject.meshHepatitis B Surface Antigens - Blooden_US
dc.subject.meshHumansen_US
dc.subject.meshLamivudine - Therapeutic Useen_US
dc.subject.meshLupus Nephritis - Complicationsen_US
dc.subject.meshMaleen_US
dc.subject.meshMiddle Ageden_US
dc.subject.meshRetrospective Studiesen_US
dc.subject.meshVirus Activationen_US
dc.titleManagement of hepatitis B reactivation in patients with lupus nephritisen_US
dc.typeArticleen_US
dc.identifier.emailYung, S:ssyyung@hku.hken_US
dc.identifier.emailChan, TM:dtmchan@hku.hken_US
dc.identifier.authorityYung, S=rp00455en_US
dc.identifier.authorityChan, TM=rp00394en_US
dc.description.naturelink_to_subscribed_fulltexten_US
dc.identifier.doi10.1007/s00296-008-0823-1en_US
dc.identifier.pmid19159933-
dc.identifier.scopuseid_2-s2.0-69049083448en_US
dc.identifier.hkuros157926-
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-69049083448&selection=ref&src=s&origin=recordpageen_US
dc.identifier.volume29en_US
dc.identifier.issue11en_US
dc.identifier.spage1273en_US
dc.identifier.epage1277en_US
dc.identifier.isiWOS:000269059800002-
dc.publisher.placeGermanyen_US
dc.identifier.scopusauthoridTse, KC=7102609864en_US
dc.identifier.scopusauthoridYung, S=22636568800en_US
dc.identifier.scopusauthoridTang, C=8681865300en_US
dc.identifier.scopusauthoridYip, TPS=7004283977en_US
dc.identifier.scopusauthoridChan, TM=7402687700en_US
dc.identifier.citeulike3942460-

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