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Hepatitis B and C virus infection in Crohn's disease
L Biancone1, M Pavia, G Del Vecchio Blanco
1Università di Roma Tor Vergata, Rome, Italy. biancone@med.uniroma2.it
Insights
Patients with Crohn's disease (CD) have higher rates of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections, particularly younger patients due to increased surgery. Immunomodulatory drugs did not impact infection or disease course.
Area of Science:
- Gastroenterology
- Hepatology
- Infectious Diseases
Background:
- Crohn's disease (CD) patients face elevated risks for hepatitis C virus (HCV) and hepatitis B virus (HBV) infections, often linked to medical procedures.
- The prevalence of these viral infections in CD patients and the impact of immunomodulatory therapies remain under-investigated.
Purpose of the Study:
- To determine the prevalence and risk factors of HCV and HBV infections in Crohn's disease (CD) patients.
- To evaluate the influence of immunomodulatory drugs on hepatitis virus infections in CD and interferon-alpha (IFN-alpha) on CD activity.
Main Methods:
- A multicenter study involving 332 CD patients, 162 ulcerative colitis (UC) patients, and 374 controls.
- Sera were tested for HBV and HCV markers (HBsAg, HBsAb, HBcAb, HBeAg, HBeAb, anti-HCV, HCV-RNA).
- Risk factors were assessed using multivariate statistical analysis.
Main Results:
- HCV or HBV infection was detected in 24.7% of CD patients. HCV prevalence was higher in CD patients under 50 compared to controls (p=0.01).
- Key risk factors for HCV in CD included surgery (OR 1.71), blood transfusions (OR 3.39), and age (OR 2.3).
- HBcAb positivity was higher in CD (10.9%) and UC (11.5%) than controls (5.1%), associated with age and gender in CD.
Conclusions:
- HBV prevalence is higher in CD patients across all ages, while HCV prevalence is elevated in younger CD patients, primarily due to surgical needs.
- HCV prevalence was significantly higher in CD than UC, suggesting immune response may play a role in HCV susceptibility.
- Current findings indicate that while HBV and HCV infections are more common in CD patients, they may not necessitate changes in CD treatment strategies.
Abstract:
Patients with Crohn's disease (CD) are at higher risk of hepatitis C (HCV) and B virus (HBV) infection, because of surgical and/or endoscopic procedures. However, the prevalence of HCV and HBV infection in CD is unknown. This issue may be relevant because of the growing use of immunomodulatory drugs in CD. The purpose of this study was to assess, in a multicenter study, the prevalence and risk factors of HCV and HBV infection in CD. The effect of immunomodulatory drugs for CD on the clinical course of hepatitis virus infections and of interferon-alpha (IFN-alpha) on the course of CD was examined in a small number of patients. Sera from 332 patients with CD and 374 control subjects (C) were tested for the following: hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (HBsAb), HBcAb, HBeAg, HBeAb, anti-HCV, and HCV-RNA. An additional 162 patients with ulcerative colitis (UC) were tested as a disease control group. Risk factors were assessed by multivariate statistical analysis. Infection by either HCV or HBV was detected in 24.7% of patients with CD. In the age groups younger than 50 years, HCV prevalence was higher in CD than in C (p = 0.01). HCV infection in CD was associated with surgery (OR 1.71; 95% CI 1.00-2.93; p = 0.04), blood transfusions (OR 3.39; 95% CI 1.04-11.04; p = 0.04), and age (OR 2.3; 95% CI 1.61-3.56; p < 0.001). The event CD-related surgery appeared to be the main risk factor for HCV infection in CD. HCV prevalence was higher in CD (7.4%) than in UC (0.6%) (p = 0.001). HBcAb positivity was higher in CD (10.9%) and UC (11.5%) than in C (5.1%) (CD vs. C: p = 0.016; UC vs. C: p = 0.02), associated with age (OR 2.08; 95% CI 1.37-3.17; p = 0.001) and female gender (OR 2.68; 95% CI 1.37-3.17; p = 0.001) in CD and to UC duration (OR 1.20; 95% CI 1.06-1.36; p = 0.002). Immunomodulatory drugs did not influence the course of HBV or HCV infection in seven patients with CD, and IFN-alpha for chronic hepatitis C did not affect CD activity in six patients with CD. It is concluded that HBV prevalence is higher in CD than in C at all ages, whereas HCV prevalence is increased in young patients with CD, because of a greater need for surgery. The higher HCV (but not HBV) prevalence in CD than in UC suggests that the host immune response may influence the risk of HCV infection. Although a relatively high proportion of patients with CD showed HBV and/or HCV infections, this should not influence treatment strategies for CD.