Liver dysfunction related to hepatitis B and C in patients with inflammatory bowel disease treated with immunosuppressive therapy
| Autor: | C, Loras, J P, Gisbert, M, Mínguez, O, Merino, L, Bujanda, C, Saro, E, Domenech, J, Barrio, M, Andreu, I, Ordás, L, Vida, G, Bastida, F, González-Huix, M, Piqueras, D, Ginard, X, Calvet, A, Gutiérrez, A, Abad, M, Torres, J, Panés, M, Chaparro, I, Pascual, M, Rodriguez-Carballeira, F, Fernández-Bañares, J M, Viver, M, Esteve, Llúcia Titó, Espinagosa |
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| Rok vydání: | 2010 |
| Předmět: |
Adult
Liver Cirrhosis Male Hepatitis B virus medicine.medical_specialty HBsAg medicine.medical_treatment Hepacivirus Opportunistic Infections Gastroenterology Inflammatory bowel disease Immunocompromised Host Hepatitis B Chronic Internal medicine medicine Humans medicine.diagnostic_test business.industry virus diseases Immunosuppression Hepatitis C Hepatitis C Chronic Middle Aged Hepatitis B Inflammatory Bowel Diseases medicine.disease Ulcerative colitis digestive system diseases Spain Female Virus Activation Viral disease Chemical and Drug Induced Liver Injury Liver function tests business Immunosuppressive Agents |
| Zdroj: | Gut. 59:1340-1346 |
| ISSN: | 0017-5749 |
| DOI: | 10.1136/gut.2010.208413 |
| Popis: | Background There is no information about the frequency of liver dysfunction in patients with inflammatory bowel disease (IBD) treated with immunosuppressants and infected with hepatitis B (HBV) and/or C virus (HCV). Aim To assess the influence of immunosuppressants on the course of HBV and HCV infection in IBD. Methods Patients with IBD with HBV and/or HCV infection from 19 Spanish hospitals were included. Clinical records were reviewed for the type of immunosuppressant used, treatment duration, liver function tests and viral markers before, during and after each immunosuppressant. Logistic and Cox regression analysis were used to identify predictors of outcome. Results 162 patients were included; 104 had HBV markers (25 HBsAg positive) and 74 had HCV markers (51 HCV-RNA positive), and 16 patients had markers of both infections. Liver dysfunction was observed in 9 of 25 HBsAg positive patients (36%), 6 of whom developed hepatic failure. Liver dysfunction in HCV was observed in 8 of 51 HCV-RNA positive patients (15.7%), and only one developed hepatic failure. The frequency and severity of liver dysfunction was significantly higher in HBV-infected patients than in HCV-infected patients (p=0.045 and p=0.049, respectively). Treatment with ≥2 immunosuppressants was an independent predictor of HBV reactivation (OR 8.75; 95% CI 1.16 to 65.66). The majority of patients without reactivation received only one immunosuppressant for a short period and/or prophylactic antiviral treatment. No definite HBV reactivations were found in anti-HBc positive patients lacking HBsAg. Conclusion Liver dysfunction in patients with IBD treated with immunosuppressants is more frequent and severe in those with HBV than in HCV carriers and is associated with combined immunosuppression. |
| Databáze: | OpenAIRE |
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