Patients with IBD have high risk of infection by hepatitis viruses B or C because during the course of their disease, they need blood transfusions, and sometimes surgical and endoscopic procedures for diagnosis and treatment. It is important to alert health professionals about prevention and early diagnosis of HBV infection because the steroids and immunosuppressant drugs used in IBD treatment worsen the HBV liver disease. Few studies exist to verify if these drugs influence HBV infection in IBD patients.
A research article to be published on 28 May 2008, in the World Journal of Gastroenterology addresses this question. The research team led by Prof. Yolanda Faia Manhes Tolentino from Federal University of Rio de Janeiro evaluated the prevalence of HBV infection in IBD patients that followed up in the hospital and the possible risk factors involved in HBV infection transmission in the patients group.
It was a cross-sectional study for which 176 patients were selected according to their arrival for the medical interview. All those patients had already IBD diagnosis. The patient was interviewed and a questionnaire was filled out.
It was concluded that there was a high incidence of positive anti-HBc (17%) and positive HBsAg (2.3%) in IBD patient when compared with the overall population (7.9%).
The statistical analysis couldn't identify one possible risk factor for HBV transmission but the study found among the IBD patients 4 persons with positive HBsAg that was called inactive bearers. Studies show that immunological supression caused by steroids, immunosupressants drugs and the anti-TNF (anti necrosis antibodies - Infliximab) in IBD patients can influence the course of hepatic disease once used in HBsAg positive patients. Those drugs would take a viral replication and infection spread inside hepatocytes. It has already been related 1 case of hepatic insufficiency and death in a Crohn's disease (CD) patient and 1 case of fulminant hepatitis in rheumatoid arthritis patient both with positive HBsAg and treated with these drugs. In patients with positive HBsAg, it would be recommended the lamivudine use before immunological suppression.
After this study, it was recommended HBV vaccination for IBD patients that have never been infected by BV and also recommend lamivudine for patients with positive anti-HBc and needs to use steroids and immunomodulators.
|Contact: Lai-Fu Li|
World Journal of Gastroenterology