Department of gastroenterology, Habib Thameur Hospital. Tunis, Tunisia; Faculty of medecine of Tunis, El Manar University. Tunis, Tunisia.
Rev Gastroenterol Peru. 2020 Jul-Sep;40(3):246-251.
Immunosuppressive drugs have become a mainstay of therapy for the inflammatory bowel diseases (IBD). These treatments expose to a risk of hepatitis B and C reactivation.
The aim of this study was to assess the prevalence of hepatitis B and C viruses in Tunisian IBD patients on immunosuppressive treatments.
Patients with inflammatory bowel disease were consecutively recruited over a 2 years period (2017-2018). Prevalence of viral hepatitis B and C as well as clinical, biological and virological presentation, management and outcome were assessed. Factors associated to hepatitis B and C were also analyzed (SPSS software, p value <0.05).
Seventy four patients with IBD were included: 38 women and 36 men. Among them 62 (83.8%) had CD and (16.2%) had UC. Mean age was 43.5±14.2 years. Six patients (8.1%) had at least one positive HVB marker. Hepatitis C infection was found in 4% patients. HBs Ag was positive in only one patient (1.3%) with positive HBV DNA. Anti HBc and anti HBs antibodies were positive respectively in 6 and 4 patients. Vaccination against hepatitis B was proposed for 22% of our patients with negative anti HBc antibodies and HBs Ag. Two patients presented non-severe acute hepatitis C with sustained virological response after antiviral treatment. IBD did not relapse under antiviral treatment. A 3rd patient had chronic hepatitis C infection. She was treated with Pegylated Interferon alpha and Ribavirine. No cases of viral reactivation have been reported. Noassociated factors to hepatitis B and C viral infections were identified in our study.
The prevalence of hepatitis B infection in IBD patients under immunosuppressive therapy was similar to the general population, while the hepatitis C prevalence was higher than the national prevalence. Screening for hepatitis B and C viral infections is mandatory in inflammatory bowel disease patients. Vaccination against hepatitis B is highly recommended.
免疫抑制剂已成为治疗炎症性肠病（IBD）的主要方法。这些治疗方法使乙型肝炎和丙型肝炎病毒重新激活的风险暴露出来。
本研究旨在评估在接受免疫抑制治疗的突尼斯 IBD 患者中乙型肝炎和丙型肝炎病毒的流行情况。
在 2017-2018 年的 2 年期间，连续招募了炎症性肠病患者。评估了乙型肝炎和丙型肝炎病毒的流行情况以及临床、生物学和病毒学表现、治疗和结果。还分析了与乙型肝炎和丙型肝炎相关的因素（SPSS 软件，p 值<0.05）。
共纳入 74 例 IBD 患者：38 名女性和 36 名男性。其中 62 例（83.8%）为 CD，（16.2%）为 UC。平均年龄为 43.5±14.2 岁。6 例（8.1%）至少有一种 HVB 标志物阳性。4%的患者感染了丙型肝炎。仅发现 1 例患者（1.3%） HBsAg 阳性，HBV DNA 阳性。抗 HBc 和抗 HBs 抗体分别在 6 例和 4 例患者中阳性。对于 22%的抗 HBc 抗体和 HBsAg 阴性的患者，建议接种乙型肝炎疫苗。2 例患者发生非严重急性丙型肝炎，抗病毒治疗后病毒学应答持续。在抗病毒治疗下，IBD 未复发。第 3 例患者患有慢性丙型肝炎感染。她接受了聚乙二醇干扰素 alpha 和利巴韦林治疗。未报告病毒再激活病例。在本研究中，未发现与乙型肝炎和丙型肝炎病毒感染相关的因素。
在接受免疫抑制治疗的 IBD 患者中，乙型肝炎感染的流行率与一般人群相似，而丙型肝炎的流行率高于全国流行率。在炎症性肠病患者中，乙型肝炎和丙型肝炎病毒感染的筛查是强制性的。强烈建议接种乙型肝炎疫苗。
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