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Vol. 4. Issue 4.
Pages 159-161 (July - August 2008)
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Vol. 4. Issue 4.
Pages 159-161 (July - August 2008)
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Infliximab in Ankylosing Spondylitis Associated With Chronic Hepatitis B Infection. Role of Lamivudine Therapy
Infliximab en la espondilitis anquilosante asociada a infección crónica por el virus de la hepatitis B. Papel del tratamiento con lamivudina
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Jesús Sanz Sanz
Corresponding author
jessanz@ya.com

Correspondence. Servicio de Reumatología. Hospital Universitario Puerta de Hierro. San Martín de Porres, 4. 28035 Madrid. España.
, Lucía Silva Fernández, José Luis Calleja Panero, Mónica Fernández-Castro, José Luis Andreu Sánchez
Servicio de Reumatología, Hospital Universitario Puerta de Hierro, Madrid, Spain
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Anti-tumor necrosis factor-a (TNF) therapy has been associated with reactivation of hepatitis B virus infection. Case reports have suggested the concomitant need of lamivudine treatment in patients with HBV infection treated with antiTNFa agents. We describe a case of ankylosing spondylitis with positive HBV surface antigen (HBsAg) treated with infliximab and lamivudine. Clinical response was excellent but when lamivudine therapy was stopped, reactivation of replication viral occurred. After the reintroduction of lamivudine, viral replication was controlled and liver function tests were normalized. Preventive long-term lamivudine therapy is mandatory when anti-TNFa therapy is maintained in patients with chronic HBV infection.

Key words:
Ankylosing spondylitis
Hepatitis B
Infliximab

El tratamiento con agentes contra el factor de necrosis tumoral (TNF) alfa se ha asociado a la reactivación de la infección crónica por el virus de la hepatitis B. Algunos casos publicados indican la necesidad de tratamiento crónico con lamivudina cuando se utilizan los agentes anti-TNFa. Describimos el caso de un paciente con espondilitis anquilosante y antígeno de superficie positivo tratado con infliximab y lamivudina. La respuesta clínica fue excelente, pero cuando el paciente interrumpió el tratamiento con lamivudina, se observó reactivación de la replicación viral. Una vez reinstaurado dicho tratamiento, se controló nuevamente la replicación viral y se normalizaron las concentraciones de transaminasas. Esta observación indica que en pacientes con infección crónica por VHB que necesitan tratamiento anti-TNFa, se requiere un tratamiento preventivo a largo plazo con lamivudina.

Palabras clave:
Espondilitis anquilosante
Hepatitis B
Infliximab
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Copyright © 2008. Sociedad Española de Reumatología and Colegio Mexicano de Reumatología
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