Should we routinely treat patients with autoimmune/rheumatic diseases and chronic hepatitis B virus infection starting biologic therapies with antiviral agents? Yes

Eur J Intern Med. 2011 Dec;22(6):572-5. doi: 10.1016/j.ejim.2011.09.001. Epub 2011 Sep 25.


It is well established that hepatitis B virus (HBV) reactivation is common among patients with various hematological or neoplastic diseases who receive chemotherapeutic agents without appropriate antiviral prophylaxis and is associated with significant morbidity and mortality. A number of recent studies have indicated that treatment with anti-tumor necrosis factor (TNF) agents in patients with autoimmune/rheumatic diseases carries a similar risk. Furthermore, appropriate pre-emptive treatment with oral antivirals appears to significantly reduce that risk and should be routinely implemented in clinical practice. Similar data are available for B-cell depleting agents like rituximab from the hematology literature, indicating the need for a similar approach in patients with autoimmune diseases receiving such agents.

MeSH terms

  • Antiviral Agents / therapeutic use*
  • Autoimmune Diseases / drug therapy*
  • Autoimmune Diseases / epidemiology
  • Autoimmune Diseases / immunology
  • Biological Therapy*
  • Hepatitis B, Chronic / drug therapy*
  • Hepatitis B, Chronic / epidemiology
  • Hepatitis B, Chronic / immunology
  • Humans
  • Immunosuppressive Agents / therapeutic use*
  • Prevalence
  • Rheumatic Diseases / drug therapy*
  • Rheumatic Diseases / epidemiology
  • Rheumatic Diseases / immunology
  • Risk Factors


  • Antiviral Agents
  • Immunosuppressive Agents