Risk of hepatitis B virus reactivation in patients with asthma or chronic obstructive pulmonary disease treated with corticosteroids

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Respirology

Early View (Articles online in advance of print)

Published Online: 12 Jul 2010

Journal compilation © 2010 Asian Pacific Society of Respirology

ORIGINAL ARTICLE

Risk of hepatitis B virus reactivation in patients with asthma or chronic

obstructive pulmonary disease treated with corticosteroids

Tae-Wan KIM, 1,2 Mi-Na KIM, 1 Jae-Woo KWON, 1,2 Kyung-Mook KIM, 1,2 Sae-Hoon

KIM, 1,2,3 Won KIM, 1 Heung-Woo PARK, 1,2 Yoon-Seok CHANG, 1,2,3 Sang-Heon CHO,

1,2 Kyung-Up MIN 1,2 AND You-Young KIM 1,2

1 Department of Internal Medicine, Seoul National University College of

Medicine, 2 Institute of Allergy and Clinical Immunology, Seoul National

University Medical Research Center, Seoul and 3 Department of Internal

Medicine, Seoul National University Bundang Hospital, Seongnam, Korea

Correspondence to Heung-Woo Park, Department of Internal Medicine, Seoul

National University College of Medicine, 28 Yongon-dong Chongno-gu, Seoul

110-744, Korea. Email: guieapark@...

Copyright Journal compilation © 2010 Asian Pacific Society of Respirology

ABSTRACT

Background and objective: Reactivation of hepatitis B virus (HBV) is thought to

be associated with immunosuppressive treatments, but insufficient information is

available on the effect of corticosteroids. The aim of this study was to

evaluate the risk of HBV reactivation in hepatitis B surface

antigen-seropositive patients with asthma or COPD, who were treated with

systemic corticosteroids (SCS) in addition to inhaled corticosteroids (ICS).

Methods: Patients with asthma or COPD (n = 198), who were hepatitis B surface

antigen-seropositive and had been treated with ICS, were identified

retrospectively. To evaluate the additional effects of SCS, the SCS group was

divided into those who received intermittent or continuous SCS (≥3 months of

continuous SCS treatment), and into those who received low-dose (≤20 mg/day of

prednisolone) or medium-to-high-dose SCS. The study outcome was HBV

reactivation.

Results: HBV reactivation occurred in 11.1% of patients in the SCS group, which

was significantly higher than the reactivation rate in the ICS group. HBV

reactivation was more frequent in the SCS group compared with the ICS group (OR

3.813, 95% CI: 1.106–13.145, P = 0.032), and in the continuous and

medium-to-high-dose SCS subgroups compared with the ICS group (OR 5.719, 95% CI:

1.172–27.905, P = 0.048 and OR 4.884, 95% CI: 1.362–17.511, P = 0.014,

respectively).

Conclusions: These results suggest that addition of SCS to ICS increases the

risk of HBV reactivation, especially when SCS are administered chronically or at

high doses.

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Received 2 December 2009; invited to revise 12 January 2010; revised 15 March

2010; accepted 15 April 2010 (Associate Editor: Grant Waterer).

DIGITAL OBJECT IDENTIFIER (DOI)

10.1111/j.1440-1843.2010.01798

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