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No Increased Risk of Hepatitis B Virus Infection in Patients with Celiac Disease: A Population-Based Study
Jacqueline Jossen1,2, Benjamin Lebwohl3,2, Jonas Söderling4
1Division of Pediatric Gastroenterology, Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY, USA.
Insights
Individuals with celiac disease (CeD) do not face an increased risk of developing hepatitis B virus (HBV) infection. This study suggests current guidelines for HBV testing and revaccination in CeD patients may not be necessary.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Immunology
Background:
- Celiac disease (CeD) is linked to suboptimal responses to hepatitis B (HBV) vaccination.
- Guidelines for HBV screening and revaccination in CeD patients are lacking.
- Understanding HBV risk in CeD is crucial for patient management.
Purpose of the Study:
- To investigate the risk of future HBV infection in individuals with CeD.
- To determine the prevalence of prior HBV infection among CeD patients.
- To inform clinical practice regarding HBV management in CeD.
Main Methods:
- A population-based Swedish cohort study (ESPRESSO) was utilized.
- 44,721 individuals with biopsy-verified CeD were matched with 222,238 reference individuals.
- Data on HBV diagnosis and prior infection were analyzed.
Main Results:
- No significant association was found between CeD and an increased risk of developing HBV (HR 0.77).
- Incidence rates of diagnosed HBV were similar between CeD patients and controls.
- Rates of prior HBV infection were low and showed a non-significant increase in CeD patients (OR 1.41).
Conclusions:
- This study found no elevated risk of HBV development in individuals with CeD.
- Findings do not support current practices of routine HBV testing and revaccination for CeD patients.
- Further research is recommended in regions with high HBV endemicity.
Objectives:
Celiac disease (CeD) has been associated with a low response to hepatitis B (HBV) vaccination, but guidelines for testing and revaccination among individuals with CeD are sparse. We examined the risk of future HBV among individuals with CeD in a population-based Swedish cohort. Furthermore, we examined the rate of prior HBV infection in CeD patients.
Methods:
All individuals in Sweden diagnosed with biopsy-verified CeD between 1990 and 2017 were identified through the ESPRESSO cohort. Each individual with CeD was matched by age, sex, calendar year, and birth country (Nordic vs. other) with up to 5 reference individuals.
Results:
We identified 44,721 CeD and 222,238 reference individuals. The incidence rates of diagnosed HBV were 2.3 and 2.9 per 100,000 person-years, respectively. This represented no association with CeD (HR 0.77 (0.45-1.30)). This null association was similar for those with a Nordic (HR 0.80 (0.40-1.60)) and non-Nordic ((HR 0.31 (0.09-1.08)) country of birth. Rates of prior HBV infection were low (CeD 0.08%, controls 0.06%). This corresponded to a small but insignificant increase among individuals with CeD (odds ratio, OR 1.41 (0.97-2.05).
Conclusion:
In a population-based Swedish cohort, there was no increased risk of developing HBV in individuals with CeD. This finding does not support current practices of testing and revaccination for HBV. Additional studies should be completed in areas with higher endemic rates of HBV. Slightly higher rates of prior HBV infection in CeD may be secondary to increased testing in those seeking medical care for another disease process.
