Axiaris G, Zampeli E, Michopoulos S, Bamias G. Management of hepatitis B virus infection in patients with inflammatory bowel disease under immunosuppressive treatment. World J Gastroenterol 2021; 27(25): 3762-3779 [PMID: 34321842 DOI: 10.3748/wjg.v27.i25.3762]
Corresponding Author of This Article
Giorgos Bamias, MD, PhD, Associate Professor, GI Unit, 3rd Academic Department of Internal Medicine, National and Kapodistrian University of Athens, Sotiria Hospital, 44 Kifisias Avenue, Athens 11526, Greece. gbamias@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Giorgos Bamias, GI Unit, 3rd Academic Department of Internal Medicine, National and Kapodistrian University of Athens, Sotiria Hospital, Athens 11526, Greece
Author contributions: Axiaris G collected the data and wrote the paper; Zampeli E, Michopoulos S, and Bamias G critically reviewed the literature and revised the paper for important intellectual content; all authors have read and approved the final manuscript.
Conflict-of-interest statement: Georgios Axiaris, Evanthia Zampeli, Spyridon Michopoulos and Giorgos Bamias have nothing to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Giorgos Bamias, MD, PhD, Associate Professor, GI Unit, 3rd Academic Department of Internal Medicine, National and Kapodistrian University of Athens, Sotiria Hospital, 44 Kifisias Avenue, Athens 11526, Greece. gbamias@gmail.com
Received: February 4, 2021 Peer-review started: February 4, 2021 First decision: April 19, 2021 Revised: April 26, 2021 Accepted: May 27, 2021 Article in press: May 27, 2021 Published online: July 7, 2021
Abstract
Hepatitis B remains a significant global clinical problem, despite the implementation of safe and effective vaccination programs. The prevalence of hepatitis B virus (HBV) in patients with inflammatory bowel disease (IBD) largely follows the regional epidemiologic status. Serological screening with hepatitis B surface antigen (HBsAg), and antibodies to hepatitis B surface (anti-HBs) and core (anti-HBc) proteins is a key element in the management of IBD patients and, ideally, should be performed at IBD diagnosis. Stratification of individual cases should be done according to the serologic profile and the IBD-specific treatment, with particular emphasis in patients receiving immunosuppressive regimens. In patients who have not contracted HBV, vaccination is indicated to accomplish protective immunity. Vaccination in immunosuppressed patients, however, is a challenging issue and several strategies for primary and revaccination have been proposed. The risk of HBV reactivation in patients with IBD should be considered in both HBsAg-positive and HBsAg-negative/anti-HBc-positive patients, when immunosuppressive therapies are administered. HBV reactivation is preventable via the administration of prophylactic nucleot(s)ide analogues and should be the standard approach in HBsAg-positive patients. HBsAg-negative/anti-HBc-positive patients represent a non-homogeneous group and bear a significantly lower risk of HBV reactivation. Biochemical, serological and molecular monitoring is currently the recommended approach for anti-HBc patients. Acute HBV infection is rarely reported in IBD patients. In the present review, we outline the problems associated with HBV infection in patients with IBD and present updated evidence for their management.
Core Tip: The management of hepatitis B virus (HBV) infection poses significant challenges for patients with inflammatory bowel disease (IBD). Lower rates of vaccination for HBV have been reported in this population and immunization programs should be encouraged and intensively implemented. In addition, patients who receive immune-modifying therapies may develop suboptimal responses to vaccination. In the presence of present or past HBV infection, immunosuppressive therapies may increase the risk for reactivation of the virus with adverse clinical outcomes. Close surveillance and/or prophylactic anti-viral treatment may be employed depending on the status of HBV infection and the IBD-specific therapy.
