Patients with chronic inflammatory bowel diseases (IBD) have long been considered at risk for viral hepatitis B. However, recent epidemiological studies have found similar prevalence, or even lower than in the general population. The objective of this work is to determine the prevalence of viral hepatitis B (HVB) during IBD, to determine the risk factors in the service of Hepato-gastroenterology of university hospital Hassan II-Fez, and of evaluate the impact on therapeutic management. PATIENTS AND METHODS: This is a retrospective study, spread over a period of 17 years and a half (January 2001-June 2017). All patients treated for IBD who are tested for Hbs Ag and anti Hbcwere included. The HVB DNA levels were tested in case of positivity of HbsAgor anti Hbc. Results: Over the study period, 755 patients were included. The average age of our patients was 35 years [14 - 87] with a sex-ratio H/F of 0.67. We had 391 cases (51.8%) of Crohn’s disease (CD) and 364 cases (48.2%) of ulcerative colitis (UC). Anti HBctest was positive in 1.98% of cases (N = 15). In these patients, HBsAg was positive in 1.19% of cases (N = 9). The prevalence of HVB was 2.55% in CD (N = 10) versus 1.37% in UC (N = 5). In our work, no history of surgery, digestive endoscopy or transfusion has been shown to be a risk factor for viral transmission. CONCLUSION: The prevalence of HVB in IBD is similar to that of the general population. The safety of blood transfusions and the improvement of asepsis probably explain these results. However, the risk of viral reactivation during HVB, sometimes fatal under immunosuppressive treatment, requires systematic screening.
KeywordsIBDUCCDHbs AgAb HbcHVB DNA LevelsPrevalenceViral Hepatitis
Fattorusso, V. and Ritter, O. (2004) Vademecum clinique: Du diagnostic au traitement. Editions Masson, 545-546.
Denis, A. (2006) L’hépatite B aigue en France: Aspects épidémiologiques. Hépato-Gastro, 13, 51-61.
Fattorusso, V. and Ritter, O. (2001) Hépatites virales. vademecum clinique, du diagnostique au traitement. 11th Edition, Masson, Paris, 1133-1141.
Sbai, A., Baha, W., Ougabrai, H., Allalia, T., Dersi, N., Lazaar, F., Ennaji, M.M., Benjouad, A., El Malki, A. and Hassar, M. (2012) Prévalence de l’infection par le virus de l’hépatite B et l’évaluation des facteurs de risque au Maroc. Pathologie Biologie, 60, e65-e69.
Nishioka Sde, A., Gyorkos, T.W. and MacLean, J,D. (2002) Tattoos and Transfusion-Transmitted Disease Risk: Implications for the Screening of Blood Donors in Brazil. Brazilian Journal of Infectious Diseases, 6, 172-180. https://doi.org/10.1590/S1413-86702002000400004
Broome, U., Glaumann, H., Hellers, G., Nilsson, B., Sorstad, J. and Hultcrantz, R. (1994) Liver Disease in Ulcerative Colitis: An Epidemiological and Follow up Study in the County of Stockholm. Gut, 35, 84-89. https://doi.org/10.1136/gut.35.1.84
Gaeta, G.B., Stroffolini, T., Taliani, G., Ippolito, F.M., Giusti, G. and De Bac, C. (1999) Surgical Procedures as a Major Risk Factor for Chronic Hepatitis C Virus Infection in Italy: Evidence from a Case-Control Study. International Journal of Infectious Diseases, 3, 207-210. https://doi.org/10.1016/S1201-9712(99)90026-7
Pallone, F., Boirivant, M., Stazi, M.A., Cosintino, R., Prantera, C. and Torsoli, A. (1992) Analysis of Clinical Course of Postoperative Recurrence in Crohn’s Disease of Distal Ileum. Digestive Diseases and Sciences, 37, 215-219. https://doi.org/10.1007/BF01308174
Hou, J.K., Velayos, F., Terrault, N. and Mahadevan, U. (2010) Viral Hepatitis and Inflammatory Bowel Disease. Inflammatory Bowel Diseases, 16, 925-932. https://doi.org/10.1002/ibd.21284
Calabrese, L.H., Zein, N. and Vassilopoulos, D. (2004) Safety of Antitumour Necrosis Factor (Anti-TNF) Therapy in Patients with Chronic Viral Infections: Hepatitis C, Hepatitis B, and HIV Infection. Annals of the Rheumatic Diseases, 63, ii18-ii24. https://doi.org/10.1136/ard.2004.028209
Abedi, F., Madani, H., Asadi, A., et al. (2011) Significance of Blood-Related High-Risk Behaviours and Horizontal Transmission of Hepatitis B Virus in Iran. Archives of Virology, 156, 629-635. https://doi.org/10.1007/s00705-010-0902-y
Mrani, S., Sakhsokh, Y., Gille, Y., et al. (2002) Epidémiologie de l’infection par les hépatites virales B et C. Cah Med, 4, 87-88.
Djeriri, K., Laurichesse, H., Merle, J., et al. (2008) Occupational Medicine Health Care Workers. Occupational Medicine, 6, 419-424. https://doi.org/10.1093/occmed/kqn071
Boulaajaj, K., Younes Elomari, Y., Elmaliki, B., et al. (2005) Infections virales: VHC, VHB et VIH chez les hémodialyses, CHU Ibn-Rochd, Casablanca. Néphrologie & Thérapeutique, 1, 274-284. https://doi.org/10.1016/j.nephro.2005.06.012
Atitar, I., Achour, J., Amrani, L., et al. (2009) Prevalence of Hepatitis B and C Markers in High Risk Hospitalized Patients in Morocco. Arab Journal of Gastroenterology, 10, 61-71. https://doi.org/10.1016/j.ajg.2009.07.074
Loras, C., Saro, C., Gonzalez-Huix, F., Mínguez, M., Merino, O., Gisbert, J.P., Barrio, J., Bernal, A., Gutiérrez, A., Piqueras, M., Calvet, X., Andreu, M., Abad, A., Ginard, D., Bujanda, L., Panés, J., Torres, M., Fernández-Banares, F., Viver, J.M. and Esteve, M. (2009) Prevalence and Factors Related to Hepatitis B and C in Inflammatory Bowel Disease Patients in Spain: A Nationwide, Multicenter Study. The American Journal of Gastroenterology, 104, 57-63. https://doi.org/10.1038/ajg.2008.4
Chevaux, J.B., Bigard, M.A., Bensenane, M., Oussalah, A., Jarlot, S., Belle, A., Nani, A., Bronowicki, J.P. and Peyrin-Biroulet, L. (2009) Inflammatory Bowel Disease and Hepatitis B and C. Gastroenterologie Clinique Et Biologique, 33, 1082-1093. https://doi.org/10.1016/j.gcb.2009.03.021
Tolentino, Y.F., Fogaca, H.S., Zaltman, C., Ximenes, L.L. and Coelho, H.S. (2008) Hepatitis B Virus Prevalence and Transmission Risk Factors in Inflammatory Bowel Disease Patients at ClementinoFragaFilho University Hospital. World Journal of Gastroenterology, 14, 3201-3206. https://doi.org/10.3748/wjg.14.3201
Biancone, L., Pavia, M., Del Vecchio Blanco, G., D’Incà, R., Castiglione, F., De Nigris, F., Doldo, P., Cosco, F., Vavassori, P., Bresci, G.P., Arrigoni, A., Cadau, G., Monteleone, I., Rispo, A., Fries, W., Mallardi, B., Sturniolo, G.C. and Pallone, F. (2001) Hepatitis B and C Virus Infection in Crohn’s Disease. Inflammatory Bowel Diseases, 7, 287-294. https://doi.org/10.1097/00054725-200111000-00002
Longo, F., Hebuterne, X., Tran, A., Staccini, P., Hastier, P., Schneider, S., Benzaken, S., Tirtaine, C. and Rampal, P. (2000) Prevalence of Hepatitis C in Patients with Chronic Inflammatory Bowel Disease in the Region of Nice and Evaluation of Risk Factors. Gastroenterologie Clinique Et Biologique, 24, 77-81.
Ishino, Y., Ido, K. and Sugano, K. (2005) Contamination with Hepatitis B Virus DNA in Gastrointestinal Endoscope Channels: Risk of Infection on Reuse after On-Site Cleaning. Endoscopy, 37, 548-551. https://doi.org/10.1055/s-2005-861316
Biancone, L., Del Vecchio Blanco, G., Pallone, F., Castiglione, F., Bresci, G. and Sturniolo, G. (2002) Immunomodulatory Drugs in Crohn’s Disease Patients with Hepatitis B or C Virus Infection. Gastroenterology, 122, 593-594. https://doi.org/10.1053/gast.2002.31602
Perrillo, R.P. (2001) Acute Flares in Chronic Hepatitis B: The Natural and Unnatural History of an Immunologically Mediated liver Disease. Gastroenterology, 120, 1009-1022. https://doi.org/10.1053/gast.2001.22461
Marusawa, H., Uemoto, S., Hijikata, M., Ueda, Y., Tanaka, K., Shimotohno, K. and Chiba, T. (2000) Latent Hepatitis B Virus Infection in Healthy Individuals with Antibodies to Hepatitis B Core Antigen. Hepatology, 31, 488-495. https://doi.org/10.1002/hep.510310232
Tanaka, E. and Urata, Y. (2012) Risk of Hepatitis B Reactivation in Patients Treated with Tumor Necrosis Factor-α Inhibitors. Hepatology Research, 42, 333-339. https://doi.org/10.1111/j.1872-034X.2011.00937.x
Madonia, S., Orlando, A., Scimeca, D., Olivo, M., Rossi, F. and Cottone, M. (2007) Occult Hepatitis B and Infliximab-Induced HBV Reactivation. Inflammatory Bowel Diseases, 13, 508-509. https://doi.org/10.1002/ibd.20035
Kohrt, H.E., Ouyang, D.L. and Keeffe, E.B. (2007) Antiviral Prophylaxis for Chemotherapy-Induced Reactivation of Chronic Hepatitis B Virus Infection. Clinical Liver Disease, 11, 965-991. https://doi.org/10.1016/j.cld.2007.08.006
Lledó, J.L., Fernández, C., Gutiérrez, M.L. and Ocana, S. (2011) Management of Occult Hepatitis B Virus Infection: An Update for the Clinician. World Journal of Gastroenterology, 17, 1563-1568. https://doi.org/10.3748/wjg.v17.i12.1563
Yeo, W., Chan, P.K., Zhong, S., Ho, W.M., Steinberg, J.L., Tam, J.S., Hui, P., Leung, N.W., Zee, B. and Johnson, P.J. (2000) Frequency of Hepatitis B Virus Reactivation in Cancer Patients Undergoing Cytotoxic Chemotherapy: A Prospective Study of 626 Patients with Identification of Risk Factors. Journal of Medical Virology, 62, 299-307. https://doi.org/10.1002/1096-9071(200011)62:3 3.0.CO;2-0
Perrillo, R.P., Schiff, E.R., Davis, G.L., Bodenheimer, H.C., Lindsay, K., Payne, J., Dienstag, J.L., O’Brien, C., Tamburro, C. and Jacobson, I.M. (1990) A Randomized, Controlled Trial of Interferon Alfa-2b Alone and after Prednisone Withdrawal for the Treatment of Chronic Hepatitis B. The Hepatitis Interventional Therapy Group. The New England Journal of Medicine, 323, 295-301. https://doi.org/10.1056/NEJM199008023230503
Esteve, M., Saro, C., Gonzalez-Huix, F., Suarez, F., Forne, M. and Viver, J.M. (2004) Chronic Hepatitis B Reactivation Following Infliximab Therapy in Crohn’s Disease Patients: Need for Primary Prophylaxis. Gut, 53, 1363-1365. https://doi.org/10.1136/gut.2004.040675
Gisbert, J.P., Chaparro, M. and Esteve, M. (2011) Review Article: Prevention and Management of Hepatitis B and C Infection in Patients with Inflammatory Bowel Disease. Alimentary Pharmacology & Therapeutics, 33, 619-633.
Rahier, J.F., Ben-Horin, S., Chowers, Y., Conlon, C., De Munter, P., D’Haens, G., Domènech, E., Eliakim, R., Eser, A., Frater, J., Gassull, M., Giladi, M., Kaser, A., Lémann, M., Moreels, T., Moschen, A., Pollok, R., Reinisch, W., Schunter, M., Stange, E.F., Tilg, H., Van Assche, G., Viget, N., Vucelic, B., Walsh, A., Weiss, G., Yazdanpanah, Y., Zabana, Y., Travis, S.P. and Colombel, J.F. (2009) European Evidence-Based Consensus on the Prevention, Diagnosis and Management of Opportunistic Infections in Inflammatory Bowel Disease. Journal of Crohn’s and Colitis, 3, 47-91. https://doi.org/10.1016/j.crohns.2009.02.010
Ott, J.J., Stevens, G.A., Groeger, J. and Wiersma, S.T. (2012) Global Epidemiology of Hepatitis B Virus Infection: New Estimates of Age-Specific HBsAg Seroprevalence and Endemicity. Vaccine, 30, 2212-2219. https://doi.org/10.1016/j.vaccine.2011.12.116
Dervite, I., Hober, D. and Morel, P. (2001) Acute Hepatitis B in a Patient with Antibodies to Hepatitis B Surface Antigen Who Was Receiving Rituximab. The New England Journal of Medicine, 344, 68-69. https://doi.org/10.1056/NEJM200101043440120
Hatzakis, A., Wait, S., Bruix, J., Buti, M., Carballo, M., Cavaleri, M., Colombo, M., Delarocque-Astagneau, E., Dusheiko, G., Esmat, G., Esteban, R., Goldberg, D., Gore, C., Lok, A.S., Manns, M., Marcellin, P., Papatheodoridis, G., Peterle, A., Prati, D., Piorkowsky, N., Rizzetto, M., Roudot-Thoraval, F., Soriano, V., Thomas, H.C., Thursz, M., Valla, D., van Damme, P., Veldhuijzen, I.K., Wedemeyer, H., Wiessing, L., Zanetti, A.R. and Janssen, H.L. (2011) The State of Hepatitis B and C in Europe: Report from the Hepatitis B and C Summit Conference. Journal of Viral Hepatitis, 1, 1-16.
Yeo, W., Chan, T.C., Leung, N.W., Lam, W.Y., Mo, F.K., Chu, M.T., Chan, H.L., Hui, E.P., Lei, K.I., Mok, T.S. and Chan, P.K. (2009) Hepatitis B Virus Reactivation in Lymphoma Patients with Prior Resolved Hepatitis B Undergoing Anticancer Therapy with or without Rituximab. Journal of Clinical Oncology, 27, 605-611. https://doi.org/10.1200/JCO.2008.18.0182