P630 Screening for latent and previous infectious diseases in inflammatory bowel disease patients: Is it a must for correct treatment decisions?
M. Ardesia*1, S. Maisano1, G. Costantino1, A. Alibrandi2, W. Fries1
1University of Messina, Department of Clinical and Experimental Medicine, Messina, Italy, 2University of Messina, Department of Economical, Financial, Social, Environmental, Statistical and Territorial Sciences, Messina, Italy
With the use of more potent immunosuppressive agents, the most recent ECCO guidelines have raised the need for a more accurate screening in IBD patients, not only to investigate former infectious disease but also to guide the choice for the therapeutic agent to use. The aim of the present study was to investigate the prevalence of hepatitis B and C, latent tuberculosis, and the immunisation status for mononucleosis, varicella, and cytomegalovirus in a cohort of IBD outpatients.
We retrospectively revised the patient’s charts from the past 6 years in our outpatient clinic; data on hepatitis B (HBsAg, anti-HBs, and anti-HBc) and C (anti-HCV), tuberculosis (TBC; Mantoux skin test or Quantiferon Gold), mononucleosis (anti-VCA IgG), varicella (anti-VZV IgG), and cytomegalovirus (anti-CMV IgG) were registered together with the following data: gender, disease, duration of disease, and IBD therapy before testing. Moreover, we evaluated anamnesis for varicella, and patients vaccinated against hepatitis B were excluded from analysis (for anti-HBs).
The charts from 1 093 IBD patients were reviewed. Data from 393 patients screened for biologic and/or thiopurine therapy were analysed (ulcerative colitis [UC] 166 and Crohn’s disease [CD] 227; mean age 43 years ± 16; males 231); median disease duration 48 months (range: 0–468); data on screening positivity are given in Table 1 by stratifying patients in 2 age groups, less than or equal to 35 years and older than 36 years.
Table 1 Percentages of positive testing for former infections
A significant positive correlation was found between age and positivity for anti-HBc (p < 0.024), latent TBC (p < 0.012), anti-VZV (p < 0.026), anti-VCA (p < 0.011), and anti-CMV (p < 0.0001), whereas type or duration of disease did not correlate with any of these markers. On univariate logistic regression, anamnestic positivity for varicella was closely associated with serum positivity for anti-VZV IgG (Exp B 35.1, CI 7.31– 68.1, p < 0.0001).
Age over 35 years significantly increases the probability to test positive for TBC, hepatitis B, anti-VZV, anti-VCA, and anti-CMV; an important percentage of younger patients was negative for Epstein–Barr virus (19%) and for varicella (17%). The first data might have implication on IBD therapy, whereas the latter data could be important for vaccination issues. When patient history reports varicella, the search for anti-VZV IgG might be unnecessary.