GAMZE TAŞ AYGAR, ASLI HAYKIR SOLAY, HANİFE KARATAŞ, BENGÜ ÇEVİRGEN CEMİL, SELDA PELİN KARTAL
Viral Hepatitis Journal - 2025;31(2):59-65
Objectives This study aimed to evaluate the risk of hepatitis B virus (HBV) reactivation in patients with a history of resolved HBV infection or isolated anti-HB core immunoglobulin G positivity who received systemic immunosuppressive therapy for psoriasis. Materials and Methods A retrospective analysis was conducted on patients ≥18 years old with psoriasis who received systemic immunosuppressive therapy (≥3 months), including methotrexate (MTX), apremilast, cyclosporine, and various biologic agents [tumor necrosis factor-alpha, interleukin (IL)-17, IL-23, IL-12/23 inhibitors] between January 2018 and March 2025. Patients with baseline HBV-DNA positivity, human immunodeficiency virus/hepatitis C virus co-infection, or incomplete data were excluded. HBV reactivation was defined as either HB surface antigen (HBsAg) seroconversion or detectable HBV-DNA. Patients were classified into three risk groups based on serological status and immunosuppressive regimen. Anti-HBs levels were categorized (<10 IU/L, 10-99 IU/L, and ≥100 IU/L), and risk factors were analyzed using Fisher’s exact test and logistic regression. RESULTS Among 1200 patients screened, 138 eligible individuals were included (63.0% male; mean age 56.9±11.8 years). Seven patients (5.0%) experienced HBV reactivation during immunosuppressive therapy, with no cases of acute hepatitis. Reactivation occurred significantly more often in HBsAg-positive and anti-HBs-negative individuals (p=0.008 and p=0.018, respectively). No reactivation was observed in patients with anti-HBs ≥10 IU/L (p<0.001). Logistic regression showed a trend toward higher reactivation risk with HBsAg positivity (odds ratio: 8.60; p=0.062). MTX, despite being classified as low risk, was associated with reactivation in HBsAg-positive patients. CONCLUSION HBV reactivation is strongly associated with HBsAg positivity and low or absent anti-HBs levels. Pre-treatment serological screening and close monitoring, especially in anti-HBs-negative individuals, are essential for safe immunosuppressive therapy in psoriasis.
