Multiple sclerosis combined with hepatitis B: distinct clinical and neuroimaging characteristics

Objective To explore whether chronic hepatitis B virus (HBV) infection could influent the clinical and neuroimaging characteristics of multiple sclerosis (MS). Methods MS patients consecutively admitted to the Third Affiliated Hospital of Sun Yat-sen University during the period of August 2014 to April 2021 were enrolled. MS were re-diagnosed according to the 2017 revisions of McDonald's criteria. The HBV infection status and clinical features, laboratory data, and MRI findings of all the patients were retrospectively reviewed. Results Ninety-three MS patients, 13 (13.98%) combined with chronic HBV infection, were included. HBV-MS groups more likely to have Optic neuropathy (p = 0.03) in the first attack. Five HBV-MS patients had atypical symptoms, which was more common than non-HBV-MS patients (p = 0.033). Brain atrophy in HBV-MS patients was more frequent than non-HBV-MS patients (p = 0.033). The initial CSF WBC count in HBV-MS patients was higher than non-HBV-MS patients (p = 0.000). Peak EDSS scores during attack before and after disease modifying therapies (DMTs) in HBV-MS patients were both higher than non-HBV-MS patients (p = 0.007 and p = 0.002, respectively). Annal relapse rate (ARR) before DMTs in HBV-MS patients was higher than non-HBV-MS patients (p = 0.00). But ARR after DMTs had no statistical difference. Conclusion Co-infection with chronic HBV aggravates MS. Patients with HBV have more severe clinical manifestations, more atypical symptoms, higher ARR, and more pronounced brain atrophy. However, HBV infection does not affect the response to DMTs.