Chronic hepatitis B reactivation following infliximab therapy in Crohn’s disease patients: need for primary prophylaxis
- 1Department of Gastroenterology, Hospital Universitari Mútua de Terrassa, Terrassa, Catalonia, Spain
- 2Department of Internal Medicine, Hospital de Cabueñes, Gijón, Asturias, Spain
- 3Department of Gastroenterology, Hospital Josep Trueta, Girona, Catalonia, Spain
- 4Department of Gastroenterology, Hospital Juan Canalejo, La Coruña, Spain
- Correspondence to:
Dr M Esteve
Department of Gastroenterology, Hospital Universitari Mútua de Terrassa, Plaça Dr Robert No 5, 08221 Terrassa, Barcelona, Catalonia, Spain;
- Accepted 25 March 2004
- Revised 16 March 2004
Background: There is little information about the effect of infliximab on the clinical course of liver disease in Crohn’s disease patients with concomitant hepatitis B virus (HBV) infection. Theoretically, immunosuppression induced by infliximab will facilitate viral replication which could be followed by a flare or exacerbation of disease when therapy is discontinued. There are no specific recommendations on surveillance and treatment of HBV before infliximab infusion. Two cases of severe hepatic failure related to infliximab infusions have been described in patients with rheumatic diseases.
Patients and methods: Hepatitis markers (C and B) and liver function tests were prospectively determined to 80 Crohn’s disease patients requiring infliximab infusion in three hospitals in Spain.
Results: Three Crohn’s disease patients with chronic HBV infection were identified. Two of the three patients with chronic HBV infection suffered severe reactivation of chronic hepatitis B after withdrawal of infliximab therapy and one died. A third patient, who was treated with lamivudine at the time of infliximab therapy, had no clinical or biochemical worsening of liver disease during or after therapy. From the remaining 80 patients, six received the hepatitis B vaccine. Three patients had antibodies to both hepatitis B surface antigen (anti-HBs) and hepatitis B core protein (anti-HBc) with normal aminotransferase levels, and one patient had positive anti-hepatitis C virus (HCV) antibodies, negative HCV RNA, and normal aminotransferase levels. Except for the patients with chronic HBV infection, no significant changes in hepatic function were detected.
Conclusions: Patients with Crohn’s disease who are candidates for infliximab therapy should be tested for hepatitis B serological markers before treatment and considered for prophylaxis of reactivation using antiviral therapy if positive.
- CD, Crohn’s disease, HBV, hepatitis B virus
- HCV, hepatitis C virus
- anti-HBs, antibodies to hepatitis B surface antigen
- anti-HBc, antibodies to hepatitis B core protein
- HBsAg, hepatitis B surface antigen
- HBeAg, hepatitis B e antigen
- anti-HBe, antibodies to hepatitis B e antigen
- ALT, alanine aminotransferase
- AST, aspartate aminotransferase
- GGT, gamma glutamyl transferase