title: Prevalence and natural history of hepatitis B and C infections in a large population of IBD patients treated with anti-tumor necrosis factor-α agents.
abstract: BACKGROUND
  The prevalence rates of hepatitis B virus (HBV) and hepatitis C virus (HCV) in patients with inflammatory bowel disease (IBD) have been reported to be higher than rates of infection among the general population. Although several cases of HBV infection reactivation in IBD patients treated with anti-TNF-α agents have been described, no evidence exists that anti-TNF-α therapy exacerbates the course of HCV. The aims of this study were to assess the prevalence of HBV and HCV and the rate of HBV vaccination in a population of IBD patients; and to investigate the long-term effects of anti-TNF-α therapy in the subgroup with HBV or HCV infections.
  
  
  METHODS
  301 patients were studied. Prior to the initiation of anti-TNF-α therapy, serum samples were tested for HBsAg and anti-HBc, anti-HBs and anti-HCV antibodies. During the follow-up, HBsAg and anti-HBc positive patients underwent periodic blood testing for viral markers, HBV-DNA and liver function; anti-HCV positive patients were assessed for liver function and HCV-RNA.
  
  
  RESULTS
  One patient was HBsAg positive (0.3%), and 22 (7.3%) tested positive for anti-HBc. Seventy-two patients (23.9%) had been vaccinated for HBV. Four patients tested positive for anti-HCV (1.3%). During anti-TNF-α therapy, none of the patients experienced HBV or HCV reactivation.
  
  
  CONCLUSIONS
  HBV and HCV infection rates were similar to infection rates among the general population. Less than one quarter of the patients had been vaccinated against HBV. Anti-TNF-α agents appear to be safe for patients with HBV infection; more data are needed for patients with HCV infection.
authors.affiliation: Internal Medicine and Gastroenterology, Catholic University of Rome, Italy. apapa@rm.unicatt.it
authors.forename: Alfredo
authors.initials: A
authors.lastname: Papa
authors.forename: Carla
authors.initials: C
authors.lastname: Felice
authors.forename: Manuela
authors.initials: M
authors.lastname: Marzo
authors.forename: Gianluca
authors.initials: G
authors.lastname: Andrisani
authors.forename: Alessandro
authors.initials: A
authors.lastname: Armuzzi
authors.forename: Marcello
authors.initials: M
authors.lastname: Covino
authors.forename: Giammarco
authors.initials: G
authors.lastname: Mocci
authors.forename: Daniela
authors.initials: D
authors.lastname: Pugliese
authors.forename: Italo
authors.initials: I
authors.lastname: De Vitis
authors.forename: Antonio
authors.initials: A
authors.lastname: Gasbarrini
authors.forename: Gian Lodovico
authors.initials: GL
authors.lastname: Rapaccini
authors.forename: Luisa
authors.initials: L
authors.lastname: Guidi
mesh_terms: D000068879:Adalimumab; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000704:Analysis of Variance; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D003093:Colitis, Ulcerative / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D003424:Crohn Disease / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D004279:DNA, Viral / Q000097:blood; D005260:Female; D016174:Hepacivirus / Q000276:immunology; D006510:Hepatitis B Antibodies / Q000097:blood; D006514:Hepatitis B Surface Antigens / Q000097:blood; D017325:Hepatitis B Vaccines; D006515:Hepatitis B virus / Q000276:immunology; D019694:Hepatitis B, Chronic / Q000453:epidemiology* / Q000276:immunology / Q000517:prevention & control; D018937:Hepatitis C Antibodies / Q000097:blood; D019698:Hepatitis C, Chronic / Q000453:epidemiology* / Q000276:immunology; D006801:Humans; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012367:RNA, Viral / Q000097:blood; D012372:ROC Curve; D013997:Time Factors; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D055815:Young Adult
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D004279:DNA, Viral; D006510:Hepatitis B Antibodies; D006514:Hepatitis B Surface Antigens; D017325:Hepatitis B Vaccines; D018937:Hepatitis C Antibodies; D012367:RNA, Viral; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab