Introduction Historically most Inflammatory Bowel Disease (IBD) patients on biological therapy have not been routinely screened for HIV, HBV, HCV, VZV immunity and TB at Northampton General Hospital. Our aim was to discover if any complication developed in patients who had not been screened according to the ECCO Guidelines for prevention of opportunistic infections.
Method We reviewed retrospectively all IBD patients who received biological treatment over a period of six months (1stApril 2013–4thNovember 2013). Previous blood tests and chest x-ray results were reviewed and patients invited to undertake any outstanding blood investigations. Clinical follow up notes were reviewed.
Results 92 patients received a biologic in the six month period. Less than 20% had prior virology testing. Subsequently, all virology tests were negative (HIVx70, HBV x69, HCVx67). All patients tested for VZV had immunity. All chest x-rays were normal.
The most notable finding was the result of the TB test as detailed in Figure 2 below. The clinical significance of this finding will be discussed later. A total of 67 patients were tested; 65 with the T-spot TB and 2 with Quantiferon-TB Gold, (the latter test was performed at a different hospital). Of these, only 16 patients (17%) were tested prior to commencement of treatment. A further 52 were tested during the audit. Of these, at the time of writing, three patients have an indeterminate T-spot TB result, two patients need retesting as their samples were unable to be processed and three patients were found to have a reactive T-spot TB test. The patients with a reactive T-spot TB test were all Caucasians and asymptomatic. They then had a chest x-ray performed, all of which showed no evidence of active TB. They have subsequently been referred to the Consultant TB Specialist for further review.
Conclusion Routinely pre-screening patients for infections in accordance with ECCO guidelines at an early stage after their IBD diagnosis seems to be a reasonable precaution and will be our practice from now on. Given the reassuring findings from our retrospective testing, it seems unlikely that there is much to be gained by screening all low risk IBD patients who have already been exposed to immunosuppressants.
Disclosure of interest None Declared.
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