Investigation of HBV reactivation in patients treated with anti-TNF agents

Background and aim: The effects of TNF-α in fighting infections are suppressed by anti-TNF treatment. HBV infection reactivation in patients using anti-TNF agents appears to be a reason limiting the use of these agents. In this study, we aimed to evaluate the safety of the drugs by investigating the HBV reactivation rate in patients using anti-TNF agents for various indications. Patients and methods: The study included 291 patients (164 men, 127 women, mean age 40±14.01) aged 18 years and over, who were followed up in Akdeniz University Hospital, Department of Gastroenterology and Hepatology, and anti-TNF agents were started for various indications in the outpatient clinic between January 1, 2015 and January 1, 2023. . The cases were patients whose HBV serology was checked before anti-TNF treatment and then they came for regular outpatient clinic checks for at least 6 months. Results: Of the cases included in the study, 164 (56.4%) were male and 127 (43.6) were female. The average age was 40.27±13.99. 169 (57.9%) of the patients had Crohn's disease and 122 (42.1%) had UC. 167 (57.4%) of these patients had Infiliximab, 112 (38.5%) had Adalimumab and 12 (42.1%) had UC. 4.1%) were using Certolizumab. Of the patients included in the study, 3 (1%) had Chronic HBV (HbsAg positive) and 63 (21%) had healed/resolved HBV infection (HbsAg negative, Anti HBc positive). Chronic All HBV patients were receiving anti-viral treatment. Three (4,7%) of the patients with recovered HBV infection were receiving antiviral prophylaxis. HBV reactivation was not detected in any of these patients. Conclusion: In this study, HBV reactivation was not detected in patients using anti-TNF agents. Similar results have been seen in small case series in the literature. Anti-viral prophylaxis should be given in patients with chronic HBV infection. There is no consensus regarding the administration of anti-viral prophylaxis in patients with recovered HBV infection.