Source Medical student, Concord Clinical School Sydney Medical School, University of Sydney, Australia Staff Specialist Gastroenterology, Director of Liver Services, Concord Hospital, Sydney, Australia Staff Specialist Rheumatology, Concord Hospital, Sydney, Australia Conjoint Senior Lecturer, University of Sydney, Sydney, Australia.

Background:  Biological disease-modifying anti-rheumatic drugs (bDMARDs) are effective in the management of inflammatory arthritides. Reactivation of hepatitis B virus (HBV) is a potential adverse outcome in patients treated with bDMARDs. There is currently no consensus on the approach to identifying and treating these patients with underlying HBV infection.

Aims:  To assess the risk of HBV reactivation in patients treated with bDMARDs, and to determine whether HBV screening should be carried out in all patients prior to commencing bDMARDs.

Methods:  A literature search was undertaken to identify all reports of patients with inflammatory arthritides and concurrent HBV infection being treated with bDMARDs.

Results:  Forty-three patients with HBV infection were identified, of whom eight patients developed HBV reactivation after exposure to bDMARDs. Of the patients who experienced reactivation, two had unknown infection that surfaced during bDMARD therapy. Patients who experienced reactivation were promptly treated with anti-viral therapy and saw clinical improvement. There are no long term data on these patients.

Conclusions:  HBV reactivation may result in serious consequences, including death. Tuberculosis screening prior to bDMARD treatment is already standard practice, as is HBV screening for patients undergoing cancer chemotherapy. Implementing HBV screening for all patients prior to bDMARD treatment can identify patients with chronic HBV who may require anti-viral therapy.