Researchers in Hong Kong found that the prevalence of hepatitis B virus infection in patients with inflammatory bowel disease (IBD) was similar to that of the general population.
The study, “Prevalence of hepatitis B and clinical outcomes in inflammatory bowel disease patients in a viral-endemic region,” was published in the journal BMC Gastroenterology.
The incidence of inflammatory bowel disease (IBD) is increasing in Asia. Treatment with immunosuppressive agents is the mainstay of IBD therapy, but this treatment can be associated with complications such as the reactivation of the hepatitis B virus (HBV).
International guidelines recommend that all patients with IBD that have a positive hepatitis B surface antigen (HBsAg) result should receive anti-viral treatment before starting on immunosuppressive agents. However, the risk of HBV reactivation seems to be linked to the type and magnitude of immunosuppression.
Recent guidelines from the American Gastroenterological Association (AGA) recommend that only patients at moderate to high risk should have anti-viral treatment before they start taking immunosuppressive medication. However, there is still a lack of scientific evidence to support this new recommendation.
To address this, Heyson C.H. Chan, MBChB, MRCP, from the Institute of Digestive Disease at the Chinese University of Hong Kong and colleagues conducted a retrospective analysis where they assessed the prevalence of HBV among patients with IBD, the determinants of altered transaminases (enzymes in the liver), as well as the effects of HBV infection on therapeutic strategies and clinical courses in IBD.
A total of 406 adult patients diagnosed with IBD, including those with Crohn’s disease (185 patients) and ulcerative colitis (221 patients) were included in the study.
Researchers found that the prevalence of IBD was 5.7 percent in the HBV population, which is close to the 7 percent seen in the general population. The histories of surgery and steroid use were found to be determinants of altered transaminases in IBD.
The results also revealed that there was no difference in the disease control and the choice or use of medications for the underlying disease between IBD subjects with or without HBV infection.
Researchers said there was a low risk for HBV reactivation in patients who were being treated with immunosuppressive therapy from thiopurines, a drug widely used in the treatment of IBD, unless patients were also taking steroids.
“This finding echoes the recent updated American Gastroenterological Association guideline which recommends that only patients at moderate to high risk undergoing immunosuppressive therapy should have antiviral prophylaxis,” the researchers wrote in a news release. “Based on our results and the latest AGA recommendation, we suggest that close monitoring of liver function and prompt initiation of antiviral in case of altered transaminases may be a reasonable option for IBD patients with HBV treated with thiopurines.”