The prevalence of hepatitis B virus infection in inflammatory bowel disease patients

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 Manhães 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.

Reference: Tolentino YFM, Fogaça HS, Zaltman C, Ximenes LLL, Coelho HSM. Hepatitis B virus prevalence and transmission risk factors in inflammatory bowel disease patients at clementino fraga filho university hospital. World J Gastroenterol 2008; 14(20): 3201-3206
http://www.wjgnet.com/1007-9327/14/3201.asp

Correspondence to: Yolanda Faia Manhães Tolentino, Internal Medicine Department, Gastroenterology Unit of Clementino Fraga Filho, University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro 21941-913, Brazil. yolandafaia@superig.com.br
Telephone: +55-21-25272566 Fax: +55-21-25272566

World Journal of Gastroenterology (WJG), a leading international journal in gastroenterology and hepatology, has established a reputation for publishing first class research on esophageal cancer, gastric cancer, liver cancer, viral hepatitis, colorectal cancer, and H pylori infection and provides a forum for both clinicians and scientists. WJG has been indexed and abstracted in Current Contents/Clinical Medicine, Science Citation Index Expanded (also known as SciSearch) and Journal Citation Reports/Science Edition, Index Medicus, MEDLINE and PubMed, Chemical Abstracts, EMBASE/Excerpta Medica, Abstracts Journals, Nature Clinical Practice Gastroenterology and Hepatology, CAB Abstracts and Global Health. ISI JCR 2003-2000 IF: 3.318, 2.532, 1.445 and 0.993. WJG is a weekly journal published by WJG Press. The publication dates are the 7th, 14th, 21st, and 28th day of every month. WJG is supported by The National Natural Science Foundation of China, No. 30224801 and No. 30424812, and was founded with the name of China National Journal of New Gastroenterology on October 1, 1995, and renamed WJG on January 25, 1998.