Prevalence of Chronic Hepatitis B Infection in Patients with Systemic Lupus Erythematosus: Viral Reactivation and Impact on Disease Activity
Kittiwan Sumethkul MD*, Pathikorn Srivitidkul MD*
Affiliation : * Division of Rheumatology, Department of Medicine, Rajavithi Hospital, College of medicine, Rangsit University, Bangkok, Thailand
Background : Hepatitis B virus (HBV) infection is prevalent in many parts of the world, especially in South East Asia, and
reactivation of HBV can occur after patients receive immunosuppressive agents. Systemic Lupus Erythematosus (SLE) is one
of the most important autoimmune diseases because of its high morbidity and mortality rates. Most SLE patients need
corticosteroid and immunosuppressive drugs as a treatment regimen; however, there are conflicting recommendations for
screening for HBsAg in patients undergoing immunosuppressive therapy and diverse theories about the impact of chronic
HBV infection on clinical manifestations of SLE and its activity. As there is no data on the prevalence of HBV infection in Thai
SLE patients,the primary objective of this study was to determine the prevalence of chronic HBV infection in Thai SLE patients,
and its secondary aim was to determine the impact of HBV infection in SLE patients.
Material and Method: A cross-sectional study was conducted between November 2013 and February 2014 to determine the
prevalence of HBV infection in Thai SLE patients in Rajavithi Hospital. All participants were screened for Hepatitis B surface
Antigen (HBsAg). Clinical manifestations of SLE such as arthritis, rash, nephritis, lupus nephritis, were recorded, and
abnormal laboratory investigations, including serological tests, were noted, together with details of all medications used.
Data of SLE patients with HBsAg positive were compared with those of HBsAg-negative patients.
Results : One hundred and thirty-four Thai SLE patients were included in the study, and the prevalence of HBV infection in
these patients was 1.5% (2/134), which is lower than in the Thai general population. No differences were found between
clinical manifestations of SLE, abnormal laboratory investigations, and treatments of patients with HBsAg positive SLE
patients and those of HBsAg-negative patients. Neither HBsAg-positive SLE patients nor those who were HBsAg negative had
cirrhosis or hepatocellular carcinoma. Neither group had evidence of acute transaminitis during their disease course, even
though one patient had high HBV viremia and had not received any antiviral prophylaxis.
Conclusion : The results showed that the prevalence of chronic HBV infection in SLE patients was lower than in the general
population. Even though they had received high doses of corticosteroid and immunosuppressive agents, no HBV reactivation
was found in these SLE patients with chronic HBV infection.
Keywords : Systemic lupus erythematosus, Hepatitis B virus, Prevalence, Impacts
