Burden of hepatitis B-, hepatitis C- and human immunodeficiency virus-associated arthritis in patients with rheumatic diseases
Year: 2024
Type: article
Study design: Observational Study
Abstract: There is a paucity of reliable published data especially from India regarding the burden of hepatitis B virus (HBV)-, hepatitis C virus (HCV)- and human immunodeficiency virus (HIV)-associated arthritis in patients with rheumatic diseases. There are no specific guidelines regarding screening for HBV, HCV or HIV before starting immunosuppressant therapy, which if instituted may prevent adverse outcomes from enhanced viral replication and reactivation of infection.[1] The present study was designed to determine the burden of HBV, HCV and HIV-associated arthritis in patients with rheumatic diseases. Considering the relevance to the management of rheumatic diseases and there being limited studies available, especially in India, this study was undertaken at our tertiary care teaching hospital. The study was conducted after obtaining clearance by the institutional ethics committee (IEC No. 1015; Letter Roc. No. AS/11/IEC/SVIMS/17). A written informed consent form was obtained from all the study participants. Consecutive patients with newly diagnosed rheumatic diseases presenting to our tertiary care teaching hospital between January 2020 and June 2021, were screened for inclusion in the study. Patients with septic arthritis, crystal arthropathies, osteoarthritis, those patients whose diagnosis was uncertain and those who were not willing to participate in the study were excluded. Initially, 5 mL of peripheral venous blood was drawn and sent to the microbiology laboratory. This was aliquoted and stored at 2–8°C and processed within 24 h for enzyme-linked immunosorbent assay (ELISA). This sample was used for testing the presence of HBV surface antigen (HBsAg) and anti-HCV antibody. The same sample was used for the detection of hepatitis B surface antibody (HbsAb) as well as antibodies to hepatitis B core antigen (HBcAg). HBsAb testing was done using HBsAb kit (MBS New s.r.l VIia Sportingmirasole 38–20090 Opera-Milano, Italy) which is an enzyme immunoassay. Anti-HBcAg antibody testing was done using point-of-care commercially available ELISA kits as per the manufacturer’s instructions. However, patients were referred to the Integrated Counselling and Testing Centre for testing for HIV testing, as per National AIDS Control Organisation guidelines. In patients testing positive for HCV, 2 mL of peripheral venous blood was drawn and subjected to HCV RNA detection using HELINI™ Purefast Viral RNA Mini spin prep KIT (Helini Biomolecules, Ohmlina, Chennai) with Rotor-Gene Q real-time reverse transcription polymerase chain reaction (RT-PCR) system (Qiagen, USA). If patient tested positive for HIV, 4 mL of peripheral venous blood was drawn and 2 mL was sent for HIV viral load determination using reverse transcriptase RT-PCR method using HELINI™ Purefast Viral Nucleic Acid Mini spin prep KIT (Helini Biomolecules, Ohmlina, Chennai) with Rotor-Gene Q RT-PCR system (Qiagen, USA). The other 2 mL sample was sent for determination of CD4+ cell count. All relevant investigations were carried out for the diagnosis and management of rheumatic disorders. Case definitions used in the study are shown in Table 1.[2-6]Table 1: Case definitionsDuring the period between March 2020 and June 2021, patients who presented with newly diagnosed rheumatic diseases (n = 94) to our tertiary care teaching hospital were screened for inclusion in the study. Of these, 3 patients were excluded in view of uncertain diagnosis, and consequently, 91 patients fulfilling the inclusion criteria were considered for analysis. Their mean age was 43 ± 11 years; 69 (75.8%) females were studied. The median disease duration was 1 year (range: 0.5–2 years). Rheumatoid arthritis (RA) (n = 77) and spondyloarthropathy (n = 3) were the most common rheumatic diseases seen. Of these 91 patients, HbsAg was detected in 3 patients; 2 patients had tested positive for HIV and none for HCV. One patient with polyarthritis had satisfied the definition of HBV-associated arthritis and was treated with entecavir. A patient with RA and another with systemic sclerosis were found to have coexistent HBV infection without active hepatitis and received oral glucocorticoid therapy. The patient with RA received methotrexate and hydroxychloroquine too, whereas the patient with systemic sclerosis was treated with mycophenolate mofetil. The two patients satisfying the definition of HIV-associated inflammatory arthritis had presented with oligoarthritis and polyarthritis, respectively. They were both treated with tenofovir, lamivudine and efavirenz. A comparison of the present study with other published studies across the world is given in Table 2.[7-9]Table 2: Comparison of the present study with other published studies across the worldOur observations suggest that screening patients with newly diagnosed rheumatic diseases for HBV and HIV will be beneficial for appropriate therapeutic decision-making regarding immunosuppressive treatment and initiation of antiviral therapy. Financial support and sponsorship Nil. Conflicts of interest The authors are faculty members/residents of Sri Venkateswara Institute of Medical sciences, Tirupati, of which Journal of Clinical and Scientific Research is the official Publication. Alladi Mohan is editor of Journal of Clinical and Scientific Research. The article was subject to the journal's standard procedures, with peer review handled independently of these faculty and their research groups.
Institution: Sri Venkateswara Institute of Medical Sciences
Language: English
Subfield: Rheumatology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4408583860