Viral infections in inflammatory bowel disease: Tips and tricks for correct management

Table 1 Summary of recommendations for the prevention and management of viral infections in inflammatory bowel disease

Infection	Screening prior to IM	Vaccination	Prophylaxis	Diagnosis	Therapy
HAV	IgG anti-HAV	Inactivated HAV vaccine; (2 doses, 0-6 mo)	-	IgG anti-HAV	Supportive
HCV	Ab anti-HCV; If positive HCV-RNA	-	-	Anti-HCV Ab; if positive HCV-RNA	DAA[62]
HBV	HBsAg, anti-HBs, anti-HBc;If positive HBV-DNA	Accelerated double-dose; (0, 1, 2 mo); If no response, re-vaccination; (0, 1, 2 mo) at a double-dose	In HBsAg+ (or antiHBc+); Entecavir 0.5 mg/d;Tenofovir, start 2 wk prior to IM	Exacerbation: ↑ AST/ALT; 100-fold rise HBV DNA	Entecavir 0.5-1 mg/daily; Tenofovir
HPV	Cervical smear test	bi/quadri/nine-valent;Women: 9-26 yr, Men: 11-23 yr	-	Cervical smear test	-
Influenza	-	Inactivated non-live trivalent	-	RT-PCR	Single neuraminidase inhibitor
HIV	HIV p24 Ag and Ab	-	-	Acute infection: RT-PCR	ART[99]
HSV	History of herpes lesions	-	Frequent/severe recurrence:acy-, valacy-, famci-clovir	Viral culture, H&E, RT-PCR	acyclovir, valacyclovir, and famciclovir
CMV	In steroid refractory patients	-	-	CMV inclusions in H&E + IHC followed by tissue RT- PCR	IV ganciclovir 5-7.5 mg/kg twice daily for 2 wk
VZV	VZV IgG/IgM	VZV vaccine: 4-3 wk before IM; HZ vaccine (recombinant): 2 doses, 0-3/6 mo	After exposure: VZV-Ig	RT-PCR on skin lesions	IV or PO acyclovir, valacyclovir, and famciclovir
EBV	EBV IgG/IgM	-	-	IgM VCA + and IgG EBNA -	-
SARS-CoV2	Recommended (test based on availability)	Recommended; mRNA-based; adenoviral vector	-	nasopharyngeal swabs; PCR-SARS-CoV-2	-

IM: Immune-modifier; DAA: Direct-acting antiviral; RT-PCR: Real-time polymerase chain reaction; IV: Intra-venous; PO: Per-os; HAV: Hepatitis A virus; HBV: Hepatitis B virus; HCV: Hepatitis C virus; HPV: Human papillomavirus; HIV: Human immunodeficiency virus; HSV: Herpes simplex virus; CMV: Cytomegalovirus; VZV: Varicella zoster virus; EBV: Epstein-Barr virus; SARS-CoV-2: Severe acute respiratory syndrome coronavirus 2.