title: Hepatitis B and inflammatory bowel disease: role of antiviral prophylaxis.
abstract: Hepatitis B virus (HBV) is a very common infection worldwide. Its reactivation in patients receiving immunosuppression has been widely described as being associated with significant morbidity and mortality unless anti-viral prophylaxis is administered. Treatment in inflammatory bowel disease (IBD) patients has changed in recent years and immunosuppression and biological therapies are now used more frequently than before. Although current studies have reported an incidence of hepatitis B in inflammatory bowel disease patients similar to that in the general population, associated liver damage remains an important concern in this setting. Liver dysfunction may manifest in several ways, from a subtle change in serum aminotransferase levels to fulminant liver failure and death. Patients undergoing double immunosuppression are at a higher risk, and reactivation usually occurs after more than one year of treatment. As preventive measures, all IBD patients should be screened for HBV markers at diagnosis and those who are positive for the hepatitis B surface antigen should receive antiviral prophylaxis before undergoing immunosuppression in order to avoid HBV reactivation. Tenofovir/entecavir are preferred to lamivudine as nucleos(t)ide analogues due to their better resistance profile. In patients with occult or resolved HBV, viral reactivation does not appear to be a relevant issue and regular DNA determination is recommended during immunosuppression therapy. Consensus guidelines on this topic have been published in recent years. The prevention and management of HBV infection in IBD patients is addressed in this review in order to address practical recommendations.
authors.affiliation: Department of Gastroenterology, University Hospital Fundación Alcorcón, 28922 Madrid, Spain. pilarlopezserrano@gmail.com
authors.forename: Pilar
authors.initials: P
authors.lastname: López-Serrano
authors.forename: Jose Lázaro
authors.initials: JL
authors.lastname: Pérez-Calle
authors.forename: Maria Dolores
authors.initials: MD
authors.lastname: Sánchez-Tembleque
mesh_terms: D000998:Antiviral Agents / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D006509:Hepatitis B / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control*; D006515:Hepatitis B virus / Q000187:drug effects* / Q000254:growth & development / Q000276:immunology; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy* / Q000453:epidemiology / Q000276:immunology; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D015995:Prevalence; D012307:Risk Factors; D016896:Treatment Outcome; D014775:Virus Activation / Q000187:drug effects
chemical_list: D000998:Antiviral Agents; D007166:Immunosuppressive Agents
keywords: Anti-tumor necrosis factor; Hepatitis B virus; Immunosuppressants; Inflammatory bowel disease; Prophylaxis
references.citation: J Clin Oncol. 2009 Feb 1;27(4):605-11
references.pmid: 19075267
references.citation: J Gastroenterol. 2008;43(5):397-401
references.pmid: 18592158
references.citation: Arthritis Care Res (Hoboken). 2010 Jun;62(6):749-54
references.pmid: 20535784
references.citation: Liver Int. 2008 May;28(5):718-20
references.pmid: 18433400
references.citation: Vaccine. 2012 Mar 9;30(12):2212-9
references.pmid: 22273662
references.citation: J Rheumatol. 2004 Jan;31(1):107-9
references.pmid: 14705228
references.citation: J Rheumatol. 2009 Jun;36(6):1188-94
references.pmid: 19447932
references.citation: J Crohns Colitis. 2009 Jun;3(2):47-91
references.pmid: 21172250
references.citation: N Engl J Med. 2001 Jan 4;344(1):68-9
references.pmid: 11187122
references.citation: Eur J Clin Microbiol Infect Dis. 2009 Apr;28(4):331-7
references.pmid: 18797940
references.citation: Hepatology. 2009 Sep;50(3):661-2
references.pmid: 19714720
references.citation: J Gastroenterol. 2011 Apr;46(4):556-64
references.pmid: 21246383
references.citation: Hepatology. 2006 Feb;43(2):233-40
references.pmid: 16440357
references.citation: Am J Gastroenterol. 2009 Jan;104(1):57-63
references.pmid: 19098850
references.citation: Ann Rheum Dis. 2004 Nov;63 Suppl 2:ii18-ii24
references.pmid: 15479865
references.citation: Ann Rheum Dis. 2003 Jul;62(7):686-7
references.pmid: 12810441
references.citation: Ann Rheum Dis. 2008 Feb;67(2):189-94
references.pmid: 17644554
references.citation: Hepatology. 2008 Mar;47(3):844-53
references.pmid: 18302293
references.citation: World J Gastroenterol. 2006 Feb 14;12(6):974-6
references.pmid: 16521231
references.citation: World J Gastroenterol. 2008 May 28;14(20):3201-6
references.pmid: 18506926
references.citation: Gut. 2008 Apr;57(4):549-58
references.pmid: 18178610
references.citation: Dig Dis Sci. 2005 Jan;50(1):163-6
references.pmid: 15712655
references.citation: Clin Gastroenterol Hepatol. 2006 Sep;4(9):1076-81
references.pmid: 16861051
references.citation: World J Gastroenterol. 2011 Aug 7;17(29):3448-52
references.pmid: 21876637
references.citation: Gut. 2010 Oct;59(10):1310-1
references.pmid: 20833661
references.citation: F1000 Med Rep. 2010 Nov 11;2:80
references.pmid: 21170370
references.citation: Am J Hematol. 2009 Mar;84(3):195
references.pmid: 19140189
references.citation: World J Gastroenterol. 2011 Sep 14;17(34):3881-7
references.pmid: 22025876
references.citation: Inflamm Bowel Dis. 2001 Nov;7(4):287-94
references.pmid: 11720317
references.citation: Liver Int. 2009 Mar;29(3):434-42
references.pmid: 18694399
references.citation: Hepatology. 2007 Feb;45(2):507-39
references.pmid: 17256718
references.citation: Blood Rev. 2008 May;22(3):117-26
references.pmid: 18343002
references.citation: World J Gastroenterol. 2011 Mar 28;17(12):1563-8
references.pmid: 21472122
references.citation: Clin Res Hepatol Gastroenterol. 2012 Feb;36(1):84-93
references.pmid: 21920838
references.citation: Gastroenterology. 2008 Apr;134(4):929-36
references.pmid: 18294633
references.citation: Inflamm Bowel Dis. 2010 Jun;16(6):925-32
references.pmid: 20480515
references.citation: Hepatol Res. 2012 Apr;42(4):333-9
references.pmid: 22150950
references.citation: Eur J Gastroenterol Hepatol. 2010 Apr;22(4):494-9
references.pmid: 20306568
references.citation: World J Hepatol. 2012 Mar 27;4(3):74-80
references.pmid: 22489259
references.citation: Cancer. 2010 Jan 1;116(1):115-21
references.pmid: 19899164
references.citation: World J Gastroenterol. 2011 Mar 28;17(12):1531-7
references.pmid: 21472116
references.citation: Gastroenterol Clin Biol. 2009 Dec;33(12):1082-93
references.pmid: 19896313
references.citation: Inflamm Bowel Dis. 2004 Sep;10(5):701-2
references.pmid: 15472541
references.citation: J Med Virol. 2000 Nov;62(3):299-307
references.pmid: 11055239
references.citation: Gastroenterology. 2003 Dec;125(6):1742-9
references.pmid: 14724827
references.citation: J Viral Hepat. 2011 Sep;18 Suppl 1:1-16
references.pmid: 21824223
references.citation: J Viral Hepat. 2008 Feb;15(2):89-102
references.pmid: 18184191
references.citation: Proc Soc Exp Biol Med. 2000 Mar;223(3):241-57
references.pmid: 10719836
references.citation: Arthritis Res Ther. 2009;11(6):R179
references.pmid: 19941642
references.citation: J Hepatol. 2009 Feb;50(2):227-42
references.pmid: 19054588
references.citation: Am J Hematol. 2008 Aug;83(8):673-5
references.pmid: 18528824
references.citation: Clin Liver Dis. 2007 Nov;11(4):965-91, x
references.pmid: 17981237
references.citation: Semin Liver Dis. 1986 May;6(2):97-106
references.pmid: 3529410
references.citation: J Rheumatol. 2003 Jul;30(7):1624-5
references.pmid: 12858469
references.citation: J Clin Oncol. 2012 Sep 10;30(26):3167-73
references.pmid: 22711851
references.citation: Gut. 2004 Sep;53(9):1363-5
references.pmid: 15306601
references.citation: Gut. 2010 Oct;59(10):1340-6
references.pmid: 20577000
references.citation: Inflamm Bowel Dis. 2012 Nov;18(11):2004-10
references.pmid: 22337144
references.citation: Gastroenterology. 1991 Jan;100(1):182-8
references.pmid: 1983820
references.citation: Inflamm Bowel Dis. 2007 Apr;13(4):508-9
references.pmid: 17206687
references.citation: Aliment Pharmacol Ther. 2011 Mar;33(6):619-33
references.pmid: 21416659
references.citation: Inflamm Bowel Dis. 2007 Nov;13(11):1453-4
references.pmid: 17600380
references.citation: Am J Gastroenterol. 2006 Aug;101(8):1834-40
references.pmid: 16817843
references.citation: Inflamm Bowel Dis. 2007 Nov;13(11):1450-1
references.pmid: 17712837
references.citation: Aliment Pharmacol Ther. 2011 Nov;34(10):1145-58
references.pmid: 21978243
references.citation: Clin Infect Dis. 2003 Jun 15;36(12):1602-5
references.pmid: 12802762
references.citation: J Biol Regul Homeost Agents. 2011 Apr-Jun;25(2):285-9
references.pmid: 21880218
references.citation: Gastroenterol Clin Biol. 2000 Jan;24(1):77-81
references.pmid: 10679588
references.citation: Liver Int. 2010 Sep;30(8):1241-2
references.pmid: 20345703
references.citation: Aliment Pharmacol Ther. 2010 Jan;31(1):20-34
references.pmid: 19681818