REVIEW - The A, B, Cs of viral hepatitis in the biologic era

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From Current Opinion in Rheumatology

The A, B, Cs of Viral Hepatitis in the Biologic Era

Clodoveo Ferri; Marcello Govoni; Leonard Calabrese

Medscape

Posted 28 Jul 2010

Abstract

Purpose of review

To evaluate the recent published data on the safety of biological

agents, mainly anti-TNFα and rituximab, and diagnostic difficulties in

the setting of hepatitis B virus (HBV) or hepatitis C virus (HCV)

infection and inflammatory arthritides.

Recent findings

There are important differences between HBV and HCV carriers; however,

clinical observations suggest that hepatotropic virus infection should

not preclude the treatment with biologic agents in rheumatic diseases.

Retrospective reports on limited series of HBV-infected patients with

concomitant chronic arthritis convey that careful patients'

clinico-virological assessment, in collaboration with the

hepatologist, is necessary before starting immunosuppressive

treatments, especially biological agents. Preemptive or combined

antiviral treatment is mandatory, mainly in active and inactive HBV

carriers. Occult HBV infection should be also carefully evaluated due

to potential virus reactivation. In HCV-infected patients without

chronic active hepatitis the treatment with biological agents,

anti-TNFα or rituximab, is generally useful and well tolerated.

Preliminary data suggest the possible synergic effects of combined

antivirals (alpha-interferon and ribavirin) and anti-TNFα (or

rituximab) in patients with chronic arthritis and active hepatitis C.

Summary

In all patients with chronic arthritis requiring immunomodulating

treatments both HBV and HCV infection along with liver conditions

should be evaluated before any therapeutic decisions, including

differential diagnosis among virus-related autoimmune disease and

simple comorbidity. Patients with HBV infection should be referred to

the hepatologist and correctly classified into active, inactive, and

occult carriers. Similarly, rheumatic patients with active chronic

hepatitis C must be treated with sequential or combined treatment with

antiviral and biological agents.

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Read the entire article here:

http://www.medscape.com/viewarticle/723836

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