Viral infections in inflammatory bowel disease: Tips and tricks for correct management

Abstract

Over the past decades, the treatment of inflammatory bowel diseases (IBD) has become more targeted, anticipating the use of immune-modifying therapies at an earlier stage. This top-down approach has been correlated with favorable short and long-term outcomes, but it has also brought with it concerns regarding potential infectious complications. This large IBD population treated with immune-modifying therapies, especially if combined, has an increased risk of severe infections, including opportunistic infections that are sustained by viral, bacterial, parasitic, and fungal agents. Viral infections have emerged as a focal safety concern in patients with IBD, representing a challenge for the clinician: they are often difficult to diagnose and are associated with significant morbidity and mortality. The first step is to improve effective preventive strategies, such as applying vaccination protocols, adopt adequate prophylaxis and educate patients about potential risk factors. Since viral infections in immunosuppressed patients may present atypical signs and symptoms, the challenges for the gastroenterologist are to suspect, recognize and diagnose such complications. Appropriate treatment of common viral infections allows us to minimize their impact on disease outcomes and patients’ lives. This practical review supports this standard of care to improve knowledge in this subject area.

Liver-side of inflammatory bowel diseases: Hepatobiliary and drug-induced disorders

“…Hepatitis C prevalence in IBD is similar to the general population[ 168 ]. The risk of HCV reactivation under immunosuppressive therapies used in IBD is low[ 172 , 173 ]. Small case series reported successful treatment of hepatitis C with direct-acting antiviral (DAA) in patients on anti-TNF therapy[ 170 ] and no drug-drug interaction between DAA and anti-TNF has emerged[ 174 ]; thus, concomitant treatment with DAA and anti-TNF seems to be safe, although more studies specifically addressing this setting are needed.…”

A case report of COVID-19 associated with AIDS-related pulmonary tuberculosis

“…Other AIDS-related illnesses, such as respiratory opportunistic infections, may coexist with COVID-19, which might make diagnosis, clinical course, patient care, and morbidity and mortality more di cult or fatal [5]. Patients are impacted by COVID-19, especially when there is severe immunosuppression brought on by AIDS and when HIV-related opportunistic infections are present [6].…”

Incidence rates for hospitalized infections, herpes zoster, and malignancies in patients with ulcerative colitis in Japan: an administrative health claims database analysis

“…9 Inflammatory bowel disease (IBD) is associated with cellular and humoral immune dysfunctions, resulting in susceptibility to viral infection and reactivation; studies in Western countries and Japan have demonstrated that patients with IBD are at an increased risk for herpes zoster. [9][10][11][12][13] The use of corticosteroids, thiopurines, TNFi, and combination therapy have been reported to increase the risk of herpes zoster. 11,12,14 However, the association between herpes zoster and UC therapies in patients with UC in Japan is uncertain due to a lack of data from Asian patients with UC.…”

“…Herpes zoster, caused by the reactivation of latent varicella zoster virus, is a major public health issue and the incidence rate of herpes zoster in Japan has been previously estimated to be 0.49 per 100 patient-years (95% confidence interval [CI], 0.49–0.50) in the general population [ 9 ]. Inflammatory bowel disease (IBD) is associated with cellular and humoral immune dysfunctions, resulting in susceptibility to viral infection and reactivation; studies in Western countries and Japan have demonstrated that patients with IBD are at an increased risk for herpes zoster [ 9 - 13 ]. The use of corticosteroids, thiopurines, TNFi, and combination therapy have been reported to increase the risk of herpes zoster [ 11 , 12 , 14 ].…”