This uncommissioned review article was subject to full peer-review.
Review article: prevention and management of hepatitis B and C infection in patients with inflammatory bowel disease
Article first published online: 11 JAN 2011
© 2011 Blackwell Publishing Ltd
Alimentary Pharmacology & Therapeutics
Volume 33, Issue 6, pages 619–633, March 2011
How to Cite
Gisbert, J. P., Chaparro, M. and Esteve, M. (2011), Review article: prevention and management of hepatitis B and C infection in patients with inflammatory bowel disease. Alimentary Pharmacology & Therapeutics, 33: 619–633. doi: 10.1111/j.1365-2036.2010.04570.x
- Issue published online: 14 FEB 2011
- Article first published online: 11 JAN 2011
- Publication data Submitted 3 November 2010 First decision 5 December 2010 Resubmitted 20 December 2010 Accepted 21 December 2010 EV Pub Online 11 January 2011
Aliment Pharmacol Ther 2011; 33: 619–633
Background Viral hepatitis is a very common infection.
Aim To review the prevention and management of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection in inflammatory bowel disease (IBD).
Methods Bibliographical searches were performed in MEDLINE up to September 2010.
Results The prevalence of both HBV and HCV infection in IBD patients is now similar to that of the general population. All IBD patients should be screened for HBV markers at diagnosis. Liver dysfunction in IBD patients treated with immunosuppressants is more frequent and severe in HBV than in HCV carriers and is associated with combined immunosuppression. In patients receiving anti-TNF drugs, HBV reactivation is common unless anti-viral prophylaxis is administered. HBsAg-positive patients should receive anti-viral prophylaxis before starting immunosuppressants. As interferon might worsen underlying IBD, nucleoside/nucleotide analogues are preferred for anti-viral prophylaxis in patients with HBV (tenofovir/entecavir are preferred to lamivudine). IBD patients should be vaccinated against HBV at diagnosis. The response rate to HBV vaccination is low, mainly in those receiving anti-TNF therapy. The serological response to HBV vaccine should be confirmed, and patients with an inadequate response should receive a second full series of vaccine. Peginterferon (±ribavirin) for HCV infection is as effective and safe as in non-IBD patients.
Conclusions The present manuscript poses a series of questions on the prevention and management of HBV/HCV infection in IBD, and attempts to answer them using scientific evidence in order to provide practical conclusions for the clinician.