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Hatano M, Mimura T, Shimada A, et al. Hepatitis B virus reactivation with corticosteroid therapy in patients with adrenal insufficiency. Endocrinol Diabetes Metab. 2019;2(3):e00071doi: 10.1002/edm2.71.
Hatano, M., Mimura, T., Shimada, A., Noda, M., & Katayama, S. (2019). Hepatitis B virus reactivation with corticosteroid therapy in patients with adrenal insufficiency. Endocrinology, diabetes & metabolism, 2(3), e00071. https://doi.org/10.1002/edm2.71
Hatano, Masako, et al. "Hepatitis B virus reactivation with corticosteroid therapy in patients with adrenal insufficiency." Endocrinology, diabetes & metabolism vol. 2,3 (2019): e00071. doi: https://doi.org/10.1002/edm2.71
Hatano M, Mimura T, Shimada A, Noda M, Katayama S. Hepatitis B virus reactivation with corticosteroid therapy in patients with adrenal insufficiency. Endocrinol Diabetes Metab. 2019 May 09;2(3):e00071. doi: 10.1002/edm2.71. eCollection 2019 Jul. PMID: 31294085; PMCID: PMC6613226.
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Endocrinol Diabetes Metab. 2019 May 09;2(3):e00071. doi: 10.1002/edm2.71. eCollection 2019 Jul.

Hepatitis B virus reactivation with corticosteroid therapy in patients with adrenal insufficiency.

Endocrinology, diabetes & metabolism

Masako Hatano, Toshihide Mimura, Akira Shimada, Mitsuhiko Noda, Shigehiro Katayama

Affiliations

  1. Department of Endocrinology and Diabetes Saitama Medical University Saitama Japan.
  2. Department of Rheumatology and Applied Immunology, Faculty of Medicine Saitama Medical University Saitama Japan.
  3. Kawagoe Clinic Saitama Medical University Saitama Japan.

PMID: 31294085 PMCID: PMC6613226 DOI: 10.1002/edm2.71

Abstract

OBJECTIVE: Whether or not reactivation of hepatitis B virus (HBV) might occur during corticosteroid therapy in hepatitis B surface antigen (HBsAg)-negative patients with adrenal insufficiency was investigated.

PATIENTS AND METHODS: We consecutively enrolled 66 patients with adrenal insufficiency undergoing physiological corticosteroid replacement therapy at Saitama Medical University Hospital between June 2013 and June 2014, and 220 patients with rheumatic disease receiving a pharmacologic dose of corticosteroids served as the positive control group. The latter group was separated into 101 patients treated only with corticosteroids, and 119 patients given corticosteroids plus immunosuppressants and/or disease-modifying antirheumatic drugs (DMARDs). HBsAg and antibody (Ab) levels against HBs, and hepatitis B core (HBc) were determined in all the patients. In patients with positive HBsAb and/or HBcAb, real-time PCR was performed for HBV-DNA. The incidence rates of conversion to HBV-DNA-positive status were evaluated.

RESULTS: Hepatitis B virus reactivation occurred in six patients with rheumatic disease, three of whom were receiving a pharmacological dose of corticosteroids only, and three who were receiving corticosteroids with immunosuppressants and/or DMARDs. However, no reactivation occurred in patients receiving corticosteroid replacements for adrenal insufficiency. Maintenance and maximum corticosteroid doses administered to patients with rheumatic disease were significantly greater than those in patients with adrenal insufficiency.

CONCLUSION: These results suggest that, although corticosteroid replacement therapy for adrenal insufficiency might be safe with respect to HBV reactivation, attention should be paid to HBV reactivation during corticosteroid therapy in rheumatic disease patients, since the dose of corticosteroids administered is usually large, and since other immunosuppressants are co-administered.

Keywords: adrenal insufficiency; corticosteroids; hepatitis B virus reactivation; rheumatic disease

Conflict of interest statement

Nothing to declare.

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