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International Journal of Rheumatology
Volume 2014, Article ID 926836, 9 pages
Review Article

HBV Reactivation in Patients Treated with Antitumor Necrosis Factor-Alpha (TNF-α) Agents for Rheumatic and Dermatologic Conditions: A Systematic Review and Meta-Analysis

1Division of Rheumatology, Misericordia e Dolce Hospital, Via Cavour 87/89, 59100 Prato, Italy
2Section of Hygiene, Institute of Public Health, Department of Public Health, Università Cattolica del Sacro Cuore, L.go F.Vito 1, 00168 Rome, Italy
3Translational Research Unit, Department of Epidemiology and Preclinical Research, INMI, Via Portuense 292, 00149 Rome, Italy
4Rheumatology Unit, Interdisciplinary Department of Medicine, University of Bari, Piazza Giulio Cesare 1, 70124 Bari, Italy
5Dermatology Clinic/ASF Department of Surgery and Translational Medicine, University of Florence, Via Lorenzo Il Magnifico 104, 50129 Florence, Italy
6Section of Infectious Diseases, Department of Internal Medicine, Second University of Naples, Via S. Pansini 5, 80131 Naples, Italy

Received 25 March 2014; Revised 26 May 2014; Accepted 11 June 2014; Published 7 July 2014

Academic Editor: Luis R. Espinoza

Copyright © 2014 Fabrizio Cantini et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Introduction. Antitumor necrosis factor-alpha (TNF-α) agents are widely used for treatment of rheumatic and dermatological diseases. We conducted the systematic review and meta-analysis to assess the prevalence of HBV reactivation among patients treated with anti-TNF-α. Methods and Findings. A comprehensive literature search of MEDLINE, Scopus, and ISI Web of Knowledge databases was conducted. From 21 studies included in the systematic review, 9 included patients with occult chronic HBV infection and 6 included patients with overt infection while 6 addressed both groups. Based on 10 studies eligible for meta-analysis we report pooled estimate of HBV reactivation of 4.2% (95% CI: 1.4–8.2%, : 74.7%). The pooled prevalence of reactivation was 3.0% (95% CI: 0.6–7.2, : 77.1%) for patients with occult infection, and 15.4% (95% CI: 1.2–41.2%, : 79.9%) for overt infection. The prevalence of reactivation was 3.9% (95% CI: 1.1–8.4%, : 51.1%) for treatment with etanercept and 4.6% (95% CI: 0.5–12.5%, : 28.7%) for adalimumab. For subgroup of patients without any antiviral prophylaxis the pooled reactivation was 4.0% (95% CI: 1.2–8.3%, : 75.6%). Conclusion. Although HBV reactivation rate is relatively low in patients treated with anti-TNF-α for rheumatic and dermatological conditions, the antiviral prophylaxis would be recommended in patients with overt chronic HBV infection.