GASTROENTEROLOGY ARTICLE OF THE WEEK
March 3, 2011
Gisbert JP, Chaprro M, Esteve M. Review article: prevention and management of hepatitis B and C infection in patients with inflammatory bowel disease. Aliment Pharmacol Ther 2011;33:619-633
1. Which of the following patients require antiviral therapy prior to or at the same time TNF therapy is initiated:
a. HBsAg (+), HBcAb (+), HBsAb (+), HBV-DNA non-detectable
b. HBsAg (-), HBcAb (+), HBsAb (+), HBV-DNA non-detectable, anti-HCV (+)
c. HBsAg (+), HBcAb (+), HBsAb(-), HBV-DNA 1,200 IU/ml.
d. HBsAg(-), HBcAb (-), HBsAb (-), anti-HCV (+), HCV-RNA 3.1 million
e. HBsAg (-), HBcAb (+), HBsAb(-), anti-HCV (-), HBV-DNA non-detectable
2, A patient with Crohn’s disease has HBV, HBsAg (+), HBV-DNA 4.5 million IU, ALT 135, HBeAg (-), anti-TNF therapy is planned, he is started on tenofovir 300mg daily 2 weeks prior to the first anti-TNF dose. You would continue tenofovir therapy until:
a. The anti-TNF drug is discontinued
b. 6-12 months after the anti-TNF drug is stopped
c. He becomes DNA negative
d. He becomes HBsAg negative
e. He has remained DNA negative for > 3 years and has normal liver enzymes
True or False
3. The prevalence of hepatitis B and C is higher among IBD patients
4. Azathioprine and methotrexate can be used in IBD patients with HCV infection
5. All patients with IBD should be screened for HBV and HCV at the time of IBD diagnosis as the presence of HCV or HBV alters the management of patients on immunosuppressants
6. Patients who do not achieve adequate HBsAb levels after one series of vaccines are non-responders, additional vaccination is unlikely to help
7. Corticosteroids should be avoided in IBD patients with concomitant HCV infection
8. Anti-TNF agents can be used safely in patients the HCV infection
9. Anti-TNF therapy may lower the seroconversion rate after hepatitis vaccination
10. Antiviral therapy with Interferon and ribavirin is contraindicated in IBD as it will exacerbate the IBD activity