Introduction Patients with IBD are exposed to a number of preventable and treatable opportunistic infections. Some of these infections can have potential serious and occasionally life threatening consequences and hence screening for these infections to assess and modify this when possible is recommended. ECCO consensus guidelines promote screening soon as possible following diagnosis of IBD and if feasible vaccination or treatments particularly before considering immunomodulatory treatment. However the uptake of these guidelines by clinicians and indeed patients in real world practice is limited.
Methods We collected data from a structured screening programme in a large cohort of IBD patients who were to be started on anti TNF therapy. Baseline characterestics were recorded. For this analysis we focussed on Varicella Zoster, Hepatitis B, hepatitis C, HIV, EBV and Tuberculosis. VZV IgG negative or equivocal patients were considered non-immune. We collected data on self reported varciella exposure in VZV IgG negative patients. All patients with indeterminate Quantiferon were subjected to a T-SPOT test.
Results 254 adult and paediatric onset IBD patients (138 females, 116 males) who received or considered for biologics were included in this study. Median age at diagnosis was 28 years (range 6–71). Majority of patients (189) had Crohn’s disease. 19 patients (7.5%) were Varicella non immune at screening and all had self reported history of Varicella zoster or uncertain history. 3 of these patients who did not receive vaccination (2 patient preference) had disseminated Varicella Zoster infection. Abnormal TB screening was identified in 16 patients (6.2%). Indeterminate Quantiferon with negative T-SPOT test was noted in 12 patients. 3 patients had positive Quantiferon and T-SPOT and received anti tuberculous chemoprophylaxis. I patient with Indeterminate Quantiferon and Indeterminate T-SPOT was considered low risk . EBV negative status was identified in 7 patients (2.8%) and 3 of these were young males and Thiopurines were not used or stopped in these patients. I patient each were Hepatitis C and HIV positive without clear preidentified risk profile and both received anti viral treatment. I patient identified with hepatitis B is awaiting treatment
Conclusion A significant number of preventable and treatable opportunistic infections were identified at screening in a large cohort of IBD patients receiving anti TNF therapy. Clinical assessment of risk alone without approapriate serology will overlook a number of these patients.This study highlights the need for early targeted screening in IBD patients. Cost effectiveness of this structured targetted screening needs further evaluation.
Disclosure of Interest None Declared