Intest Res.  2017 Jan;15(1):97-102. 10.5217/ir.2017.15.1.97.

Prevalence of hepatitis B, hepatitis C and human immunodeficiency viral infections in patients with inflammatory bowel disease in north India

• Harsh P
• Gupta V
• Kedia S
• Bopanna S
• Pilli S
• Surendernath
• Makharia G
• Ahuja V

• KMID: 2368491
• DOI: http://doi.org/10.5217/ir.2017.15.1.97

Abstract

BACKGROUND/AIMS
Patients with inflammatory bowel disease (IBD) often require immunosuppressive therapy and blood transfusions and therefore are at a high risk of contracting infections due to hepatitis B (HBV) and hepatitis C (HCV) and human immunodeficiency virus (HIV). In the present study, we assessed the prevalence of these infections in patients with IBD.
METHODS
This retrospective study included 908 consecutive patients with IBD (ulcerative colitis [UC], n=581; Crohn's disease [CD], n=327) who were receiving care at a tertiary care center. Ninety-five patients with intestinal tuberculosis (ITB) were recruited as disease controls. Prospectively maintained patient databases were reviewed for the prevalence of HBV surface antigen, anti-HCV antibodies, and HIV (enzyme-linked immunosorbent assay method). HCV RNA was examined in patients who tested positive for anti-HCV antibodies. Prevalence data of the study were compared with that of the general Indian population (HBV, 3.7%; HCV, 1%; HIV, 0.3%).
RESULTS
The prevalence of HBV, HCV, and HIV was 2.4%, 1.4%, and 0.1%, respectively, in the 908 patients with IBD. Among the 581 patients with UC, 2.2% (12/541) had HBV, 1.7% (9/517) had HCV, and 0.2% (1/499) had HIV. Among the 327 patients with CD, 2.8% (8/288) had HBV, 0.7% (2/273) had HCV, and 0% (0/277) had HIV. One patient with CD had HBV and HCV coinfection. The prevalence of HBV, HCV, and HIV in patients with ITB was 5.9% (4/67), 1.8% (1/57), and 1.2% (1/84), respectively.
CONCLUSIONS
The prevalence of HBV, HCV, and HIV in north Indian patients with IBD is similar to the prevalence of these viruses in the general community. Nonetheless, the high risk of flare after immunosuppressive therapy mandates routine screening of patients with IBD for viral markers.

Keyword

Inflammatory bowel disease; Colitis, ulcerative; Crohn disease; Hepatitis B; Hepatitis C

MeSH Terms

Antigens, Surface
Biomarkers
Blood Transfusion
Coinfection
Colitis
Colitis, Ulcerative
Crohn Disease
Hepatitis B*
Hepatitis C Antibodies
Hepatitis C*
Hepatitis*
HIV
Humans*
India*
Inflammatory Bowel Diseases*
Mass Screening
Prevalence*
Prospective Studies
Retrospective Studies
RNA
Tertiary Care Centers
Tuberculosis
Antigens, Surface
Biomarkers
Hepatitis C Antibodies
RNA

Figure

• 

  Fig. 1 Prevalence of HBV, HCV, and human immunodeficiency virus (HIV) in patients with IBD or intestinal tuberculosis (ITB).

Reference

1. Ahuja V, Tandon RK. Inflammatory bowel disease: the Indian augury. Indian J Gastroenterol. 2012; 31:294–296. PMID: 23150035.

2. Gisbert JP, Chaparro 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. PMID: 21416659.

3. Viazis N, Vlachogiannakos J, Georgiou O, et al. Course of inflammatory bowel disease in patients infected with human immunodeficiency virus. Inflamm Bowel Dis. 2010; 16:507–511. PMID: 19714759.

4. National HIV counseling and testing services (Hcts) guidelines. National AIDS Control Organization Website;http://naco.gov.in/sites/default/files/National%20HIV%20Counselling%20%26%20Testing%20Services%20Guideline,%20Dec%202016.pdf.

5. Hepatitis in India: burden, strategies and plans. National Centre for Disease Control Web site;Accessed February 24, 2014. http://www.ncdc.gov.in/writereaddata/linkimages/NewsLtr0103_20146480274026.pdf.

6. Satsangi J, Silverberg MS, Vermeire S, Colombel JF. The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications. Gut. 2006; 55:749–753. PMID: 16698746.

7. He Y, Xu P, Chen Y, et al. Prevalence and influences of hepatitis B virus infection on inflammatory bowel disease: a retrospective study in southern China. Int J Clin Exp Med. 2015; 8:8078–8085. PMID: 26221373.

8. Tolentino YF, Fogaca HS, Zaltman C, Ximenes LL, Coelho HS. Hepatitis B virus prevalence and transmission risk factors in inflammatory bowel disease patients at Clementino Fraga Filho University Hospital. World J Gastroenterol. 2008; 14:3201–3206. PMID: 18506926.

9. Esteve M, Saro C, González-Huix F, Suarez F, Forné M, Viver JM. Chronic hepatitis B reactivation following infliximab therapy in Crohn's disease patients: need for primary prophylaxis. Gut. 2004; 53:1363–1365. PMID: 15306601.

10. Biancone L, Pavia M, Del Vecchio Blanco G, et al. Hepatitis B and C virus infection in Crohn's disease. Inflamm Bowel Dis. 2001; 7:287–294. PMID: 11720317.

11. Chevaux JB, Nani A, Oussalah A, et al. Prevalence of hepatitis B and C and risk factors for nonvaccination in inflammatory bowel disease patients in northeast France. Inflamm Bowel Dis. 2010; 16:916–924. PMID: 19885908.

12. Loras C, Saro C, Gonzalez-Huix F, et al. Prevalence and factors related to hepatitis B and C in inflammatory bowel disease patients in Spain: a nationwide, multicenter study. Am J Gastroenterol. 2009; 104:57–63. PMID: 19098850.

13. Park SH, Yang SK, Lim YS, et al. Clinical courses of chronic hepatitis B virus infection and inflammatory bowel disease in patients with both diseases. Inflamm Bowel Dis. 2012; 18:2004–2010. PMID: 22337144.

14. Papa A, Felice C, Marzo M, et al. Prevalence and natural history of hepatitis B and C infections in a large population of IBD patients treated with anti-tumor necrosis factor-alpha agents. J Crohns Colitis. 2013; 7:113–119. PMID: 22464811.

15. Puri P. Tackling the hepatitis B disease burden in India. J Clin Exp Hepatol. 2014; 4:312–319. PMID: 25755578.

16. Nooredinvand HA, Connell DW, Asgheddi M, et al. Viral hepatitis prevalence in patients with active and latent tuberculosis. World J Gastroenterol. 2015; 21:8920–8926. PMID: 26269682.

17. Blal CA, Passos SR, Horn C, et al. High prevalence of hepatitis B virus infection among tuberculosis patients with and without HIV in Rio de Janeiro, Brazil. Eur J Clin Microbiol Infect Dis. 2005; 24:41–43. PMID: 15616838.

18. Li YD, Lin JJ, Zheng SS. Inflammatory bowel diseases and hepatitis C virus infection. Hepatobiliary Pancreat Dis Int. 2010; 9:398–401. PMID: 20688604.

19. Longo F, Hebuterne X, Tran A, et al. Prevalence of hepatitis C in patients with chronic inflammatory bowel disease in the region of NICE and evaluation of risk factors. Gastroenterol Clin Biol. 2000; 24:77–81. PMID: 10679588.