It is known that one third of the world’s population is infected with hepatitis B virus. Although the incidence of the disease in our country has decreased significantly in the last 10 years, thanks to intensive vaccination campaigns, it is known that approximately 5% of the population still carries this virus. Hepatitis B virus is a virus that can be transmitted from person to person through blood, sexually and from mother to baby, and can cause hepatitis by affecting the liver and jaundice as a symptom of it. Although the body’s defense mechanisms clear the virus in most of the patients following the infection, the disease becomes chronic in 5-10% of the people who encounter the virus. 20-40 percent of people with chronic hepatitis B develop cirrhosis, and liver cancer develops in about a quarter of them. Despite the seriousness of the consequences of the disease, very few of the cases are diagnosed in the community, and many people continue to live without knowing that they are carrying the Hepatitis B virus, unaware of the danger.
As I mentioned above, in addition to the importance of the issue for the general public, this situation has a special importance for patients who will be started on anti-TNF group (infliximab, etanercept, adalimumab) drugs due to various rheumatological diseases (rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis). . It was realized shortly after the drugs were put into use that this group of drugs caused re-inflammation by awakening (reactivating) the hepatitis B virus that was waiting in the body in a dormant state. Such situations do not prevent the use of anti-TNF group drugs, but the patient should be treated for hepatitis B virus along with these drugs.
There are various laboratory tests that allow us to understand whether the person has encountered the hepatitis virus and, if so, how the body reacts to it. Until recently, most physicians tried to make a decision about the hepatitis B status of their patients by performing only 1 or 2 of these tests for their patients who would start anti-TNF or other immunosuppressive drugs. As a rheumatologist, what we usually do is to refer the patient to a gastroenterology specialist, if the “HBsAg” test is positive, to ensure that he receives appropriate anti-viral treatment, if “anti-HBs” is positive, by convincing that the patient has previously encountered the virus and developed immunity (naturally or by vaccination). was not taking any action.
In a study conducted by Taiwanese researchers (one of the countries where hepatitis B is most common in the world) and published in the October 2011 issue of the Annals of the Rheumatic Diseases, performing the “anti-HBc” test in addition to the above-mentioned tests is somewhat revealed that hidden (unrecognizable by the other 2 tests) Hepatitis B patients could also help these patients to be monitored appropriately and to receive anti-viral therapy when necessary.
In conclusion, if you are going to use one of the anti-TNF group drugs, make sure that you have been asked for the following three tests (HBsAg, Anti-HBc, and anti-HBs) before starting these drugs.
How should hepatitis b screening be done before starting anti-TNF drug therapy?
