Objective: Anti-TNF agents are increasingly used for the treatment of many autoimmune diseases. HBV reactivation may occur by different mechanisms in anti-HBc (+) patients receiving anti-TNF therapy. In our study, we aimed to retrospectively evaluate how patients who received anti-TNF agents were managed in terms risk of HBVr.

Material and Method: The results of 2084 patients who used anti-TNF at Erciyes University were scanned. HBV management in 319 HBsAg(-) anti-HBc(+) patients was analyzed retrospectively.

Results: The mean duration of follow-up was 40.61±26.73 months. The most commonly used anti-TNF agents were adalimumab and etanercept. HBVr occurred in 8 patients (2.5%). HBVr was diagnosed as HBV-DNA increase in six patients and HBsAg seroconversion in two patients. HBVr occured 18.25±9.95 months after commencing the treatment. None of the patients who experienced reactivation had severe complications such as transaminase elevation, liver failure, death. Prophylactic antiviral treatment was used 88 of the 319 patients. Other patients were followed up with a preemptive treatment approach. HBVr occurrence rates were 1.13% (n =1) in the group receiving prophylaxis and 3.03% (n =7) in the group not receiving prophylaxis.

Conclusion: In a study evaluating anti-HBc (+) patients, no morbidity or mortality and no transaminase increase were encountered; however, the HBVr rate was slightly above 1%. Anti-TNF agents can be followed with a preemptive treatment strategy without antiviral prophylaxis in anti-HBc (+) patients. HBV-DNA, ALT, and serology should be used during follow-up. Randomized controlled trials are needed to reach a consensus.