Background There is no information about the frequency of liver dysfunction in patients with inflammatory bowel disease (IBD) treated with immunosuppressants and infected with hepatitis B (HBV) and/or C virus (HCV).
Aim To assess the influence of immunosuppressants on the course of HBV and HCV infection in IBD.
Methods Patients with IBD with HBV and/or HCV infection from 19 Spanish hospitals were included. Clinical records were reviewed for the type of immunosuppressant used, treatment duration, liver function tests and viral markers before, during and after each immunosuppressant. Logistic and Cox regression analysis were used to identify predictors of outcome.
Results 162 patients were included; 104 had HBV markers (25 HBsAg positive) and 74 had HCV markers (51 HCV-RNA positive), and 16 patients had markers of both infections. Liver dysfunction was observed in 9 of 25 HBsAg positive patients (36%), 6 of whom developed hepatic failure. Liver dysfunction in HCV was observed in 8 of 51 HCV-RNA positive patients (15.7%), and only one developed hepatic failure. The frequency and severity of liver dysfunction was significantly higher in HBV-infected patients than in HCV-infected patients (p=0.045 and p=0.049, respectively). Treatment with ≥2 immunosuppressants was an independent predictor of HBV reactivation (OR 8.75; 95% CI 1.16 to 65.66). The majority of patients without reactivation received only one immunosuppressant for a short period and/or prophylactic antiviral treatment. No definite HBV reactivations were found in anti-HBc positive patients lacking HBsAg.
Conclusion Liver dysfunction in patients with IBD treated with immunosuppressants is more frequent and severe in those with HBV than in HCV carriers and is associated with combined immunosuppression.
- Liver dysfunction
- hepatitis B
- hepatitis C
- inflammatory bowel disease
- immunosuppressive therapy
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Study organisation and investigators from the GETECCU and REPENTINA group of the Spanish Gastroenterological Association who participated in the study: Hospital Universitario Mútua de Terrassa: Montserrat Forné, Mercè Rosinach, Jorge Carlos Espinós, Rocio Temiño, Victoria Gonzalo. Hospital Clínico Universitario de Valencia: Francisco Mora. Hospital de Donostia, San Sebastian-Guipúzcoa: Ana Muñagorri, Maria Belen Irastorza, Ines Gil, Arantxa Iribarren, José R Sáenz. Hospital de Cabueñes, Gijón, Asturias: Cristobal de la Coba Ortiz. Hospital Universitario Germans Trias i Pujol, Badalona: Eduard Cabré, Miriam Mañosa. Hospital Universitario Río Hortega, Valladolid: Jesús Barrio, Paula Gil-Simón, Ramón Atienza. Hospital Reina Sofía, Córdoba: Federico Gómez Camacho, Eva Iglesias Flores, Valle García Sánchez. Hospital la Fe de Valencia: Andrea Nevarez, Cristina Sanchez. Hospital Josep Trueta, Girona: Marcela Perez. Consorci de Terrassa: Jaume Boadas, Jordi Ortiz, David Montfort. Hospital Parc Taulí de Sabadell: Antònia Montserrat, Albert Villòria. Hospital de St Llorenç, Viladecans: Mercè Barenys, Ana Belen Vega. Hospital de l’Esperit Sant, Barcelona: Llúcia Titó Espinagosa.
Funding CIBEREHD is funded by the Instituto de Salud Carlos III.
Competing interests None.
Ethics approval This study was conducted with the approval of the ethics committee of the Hospital Universitari Mútua de Terrassa.
Provenance and peer review Not commissioned; externally peer reviewed.