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P298. Effect of immunosuppressive and biologic therapy in patients with inflammatory bowel diseases and HBV or HCV infection – A multicentre retrospective study

A. Rispo1, F. Morisco1, F. Castiglione1, A. Orlando2, L. Biancone3, R. Vitale1, G. Riegler4, M. Vecchi5, R. Granata1, F. Sasso1, C. D'Onofrio1, N. Caporaso1

1Gastroenterology – University “Federico II” of Naples, Naples, Italy; 2Ospedale V. Cervello, Palermo, Italy; 3Gastroenterology – University “Tor Vergata”, Rome, Italy; 4Gastroenterology – Second University of Naples, Naples, Italy; 5Gastroenterology – IRCCS Policlinico San Donato & University of Milan, Milan, Italy

Background: Hepatitis B reactivation has been widely reported in patients undergoing immunosuppressive therapy in onco-hematological and transplant settings with a frequency of 20–50%, whereas the risk of hepatitis C reactivation seems to be absent or significantly lower. Differently, few data are available about the risk of HBV and HCV reactivation in patients with inflammatory bowel disease (IBD) receiving biological and non biological immunosuppressive drugs.

Aims: (1) To assess the prevalence of HBV and HCV infection in a consecutive series of patients with IBD, observed in the last decade in Italy and; (2) to value the effects of immunosuppressive and biologic therapy on the course of HBV and HCV infection.

Patients and Methods: Retrospective observational multicentre study including all consecutive patients with IBD attended in 5 Italian hospitals (over an 8 years period) between January 2000 and December 2008. A standardized, precoded questionnaire, was used to collect information on socio-demographic characteristics (age, gender, level of education), IBD characteristics, HBV and HCV markers, and therapeutic approach.

Results: A total of 3875 IBD patients were consecutively included: 1856 Crohn's disease (CD) and 2019 Ulcerative Colitis (UC). Among patients with CD, 735 (39.6%) were tested for HBV and HCV markers: 8 (1.09%) were HBsAg+, 8 (1.09%) were isolated anti-HBc+ and 22 (2.99%) were anti-HCV+. Among patients with UC, 575 (28.47%) were tested for HBV and HCV markers: 11 (1.91%) were HBsAg+, 8 (1.39%) were isolated anti-HBc+ and 25 (4.34%) were anti-HCV+. No coinfection HBV/HCV or HBV/HDV was observed.

At all, 20 patients with HBV or HCV infection received immunosuppressive and/or biologic therapy (7 HBsAg+; 3 isolated anti-HBc+ and 10 anti-HCV+). Two out of these 7 patients HBsAg+ (both in combined treatment with infliximab and azathioprine), 0/3 anti-HBc+, and 1/10 anti-HCV+ (on therapy with azathioprine), experienced reactivation of hepatitis.

Conclusions: 1. In tertiary Italian centres a high percentage of patients with IBD were not tested for HBV and HCV infection; 2. IBD HBsAg+ patients undergoing immunosuppressive/biologic therapy show an high percentage of HBV reactivation; 3. The low number of patients does not permit definite information on the risk of reactivation in subjects with isolated anti-HBc positivity.