Management of hepatitis B virus infection in patients with inflammatory bowel disease under immunosuppressive treatment

Axiaris, Georgios; Zampeli, Evanthia; Michopoulos, Spyridon; Bamias, Giorgos

doi:10.3748/wjg.v27.i25.3762

Cited by 9 publications

(4 citation statements)

References 100 publications

(143 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In anti-HBc positive patients, antiviral prophylaxis can be proposed particularly for treatments at high risk of reactivation [ 3 , 9 ]. Non-immunized patients should be proposed vaccination at the time of IBD diagnosis and before initiating immunomodulatory treatment [ 2 , 10 ]. Yet, this patient benefited from a correct full vaccine scheme a few years earlier as reported in his medical file.…”

Section: Discussionmentioning

confidence: 99%

“…Early vaccination, before immunosuppressive treatment initiation is preferable as the HBV vaccine response rate in patients using immunomodulators is dramatically decreased, in particular in infliximab-users, even with high dose vaccine [ 12 , 13 ]. An anti-HBs titer above 10 IU/L such as recommended in healthy individuals may not be sufficient for IBD patient; the definition of a minimal threshold in such situation would be useful [ 10 ]. Thus, efforts should be made to vaccinate IBD patients against HBV or to give a booster dose to maintain high anti-HBs Ab levels before immune suppressive therapy.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Acute hepatitis B virus infection despite vaccination in a patient treated by infliximab: a case report

et al. 2022

View full text Add to dashboard Cite

Background Despite an effective vaccine, hepatitis B remains a major global health problem due to its significant morbidity and mortality. Vaccination in immunosuppressed patients such as those treated for an inflammatory bowel disease (IBD) can be less effective. This case describes an uncommon original diagnosis of an acute hepatitis B infection occurring in a vaccinated but immunocompromised IBD patient under long-term infliximab treatment. A low anti-HBs titer and the presence of HBsAg escape mutations are possible hypotheses to explain this unexpected infection. Case presentation A 28-year-old Caucasian male, regularly followed-up for a Crohn’s disease treated by infliximab, was regularly screened for sexually transmissible infections because of at-risk behaviors. Despite a correct immunization scheme against hepatitis B virus (HBV), an active HBV infection was diagnosed during one of those screenings. Retrospective testing of a sample collected 6 months earlier was in favor of an evolution from an acute hepatitis B toward a chronic hepatitis B. The patient has always had a low anti-HBs antibody levels (near the threshold of 10 IU/L) possibly explaining his infection. In addition, HBV sequencing revealed a genotype A2 HBV strain, carrying the sD144A substitution on the S protein, known as a potential immune escape variant. Dual therapy combining tenofovir disoproxil fumarate and emtricitabine, active against HBV but also efficient as an HIV pre-exposure prophylaxis, was initiated. Ten months after treatment initiation, all surrogate biochemical and virological endpoints for HBV functional cure were achieved. Treatment and periodical monitoring are being maintained. Conclusion Emphasis should be placed on HBV screening, vaccination and regular monitoring of patients under long-term immunosuppressive therapy, particularly those with at-risk behaviors.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Acute hepatitis B virus infection despite vaccination in a patient treated by infliximab: a case report

et al. 2022

View full text Add to dashboard Cite

show abstract

“…44,45 Hepatitis B virus incidence in individuals with IBD in many countries is reported to closely reflecting the general public epidemiologic status. 46 HBV infection has been reported to cause fulminant or fatal hepatitis in IBD patients due to opportunistic infection or reactivation of HBV, but it is prevented with a vaccine. 47,48 The nature of the disease, immunosuppressive medications such as biologics and immunomodulators, and procedures such as endoscopy, transfusion, and surgery, which are frequently necessary during treatment, all enhance the risk of infectious disease in patients with IBD.…”

Section: Hepatitis B Vaccinementioning

confidence: 99%

Vaccination for Inflammatory Bowel Disease Patients

Yunihastuti

2022

InaJGHE

View full text Add to dashboard Cite

Inflammatory bowel disease (IBD) patients have an increased rate of some vaccine-preventable infection during their course of disease. However, the coverage of vaccination is still low. Many physicians often do not feel comfortable or confidence offering vaccination to IBD patients. Vaccine effectiveness can be altered by the immune dysregulation condition and immunosuppressive therapy that IBD patients use. There are also some concerns about IBD flare after vaccination and potential adverse events related to live vaccines. Nonetheless, offering vaccines and obtaining vaccination history is necessary for health care maintenance of IBD patients, especially those using immunosuppressive therapy.

show abstract

“…Its prevalence has altered over the past 30 years because of immigration, socioeconomic progress, and the introduction of a vaccine. Research in Europe, Asia, and the Americas has identified a varied range of HBV prevalence in IBD patients, ranging from 0.5% to 15% [8]. In 2016, the World Health Organization (WHO) invited all countries to collaborate in a campaign aiming to eradicate viral hepatitis, including HBV, by the year 2030 [9].…”

Section: Introductionmentioning

confidence: 99%

Immunogenicity of Hepatitis B Vaccination in Patients with Ulcerative Colitis on Infliximab Is Attenuated Compared to Those on 5-Aminosalicylic Acid Therapies: A Prospective Observational Study

Shehab,

Alrashed,

Alyaseen

et al. 2024

Vaccines

View full text Add to dashboard Cite

Introduction: Hepatitis B virus (HBV) infection has been associated with chronic hepatitis and cirrhosis. Patients with inflammatory bowel disease (IBD) may be at a higher risk of HBV infection reactivation, especially those on biologic therapies. This study intends to compare the effectiveness of the HBV vaccine in patients with ulcerative colitis (UC) on infliximab (IFX) compared to those on 5-aminosalicylic acid (5-ASA). Methods: Patients with UC aged >18 years old were prospectively enrolled in the study. The patients were divided into two groups: patients treated with 5-ASA (control group) and patients treated with IFX (study group). HBV vaccination was administered (20 mcg) following the standard regimen, and Hepatitis B serum antibody (HbsAb) titers were assessed three months after the final dose. The response to HBV vaccines was categorized as an ‘adequate’ immune response (≥10 IU/L) and ‘effective’ immune response (≥100 IU/L). Results: In our final analysis of 118 patients with UC, 54.2% were male and 52.5% had extensive colitis. HBsAb titer levels were significantly higher in the 5-ASA group (126.7 ± 37.5) compared to the IFX group (55.5 ± 29.4). Stratifying HBsAb levels into two categories (≥10–99 IU/L and ≥100 IU/L) revealed a significantly greater proportion of subjects in the 5-ASA group with levels ≥100 IU/L compared to the IFX group (76.7% vs. 12.1%, p < 0.001). Logistic regression analysis demonstrated that patients with UC receiving 5-ASA were 23.94 times more likely to exhibit HBsAb levels ≥ 100 compared to those treated with IFX (OR = 23.94, 95% CI 8.89–64.49). Conclusion: The immune response to hepatitis B vaccination in patients with ulcerative colitis treated with IFX is attenuated compared to those treated with 5-ASA. Therefore, emphasizing the importance of HBV vaccination for patients with IBD before starting anti-TNF therapy, especially IFX, and advocating for screening is imperative in high-risk countries. Determining what levels of HBsAb provide protection and what happens to the levels over time after a booster dose are important clinical questions to be answered by follow-up studies.

show abstract

Management of hepatitis B virus infection in patients with inflammatory bowel disease under immunosuppressive treatment

Cited by 9 publications

References 100 publications

Acute hepatitis B virus infection despite vaccination in a patient treated by infliximab: a case report

Acute hepatitis B virus infection despite vaccination in a patient treated by infliximab: a case report

Vaccination for Inflammatory Bowel Disease Patients

Immunogenicity of Hepatitis B Vaccination in Patients with Ulcerative Colitis on Infliximab Is Attenuated Compared to Those on 5-Aminosalicylic Acid Therapies: A Prospective Observational Study

Contact Info

Product

Resources

About