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World J Gastroenterol. Apr 7, 2014; 20(13): 3516-3524
Published online Apr 7, 2014. doi: 10.3748/wjg.v20.i13.3516
Hepatitis B and C virus reactivation in immunosuppressed patients with inflammatory bowel disease
Stefano Sansone, Maria Guarino, Fabiana Castiglione, Antonio Rispo, Francesco Auriemma, Ilaria Loperto, Matilde Rea, Nicola Caporaso, Filomena Morisco
Stefano Sansone, Maria Guarino, Fabiana Castiglione, Antonio Rispo, Francesco Auriemma, Ilaria Loperto, Matilde Rea, Nicola Caporaso, Filomena Morisco, Gastroenterology Unit, Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy
Author contributions: Sansone S, Guarino M and Morisco F wrote the paper; all authors made a substantial contribution to interpretation of the data, revised the manuscript critically for important intellectual content and approved the final version to be published.
Correspondence to: Filomena Morisco, Professor, Gastroenterology Unit, Department of Clinical Medicine and Surgery, University of Naples “Federico II”, via Sergio Pansini, 5, 80131 Napoli, Italy. filomena.morisco@unina.it
Telephone: +39-81-7464746 Fax: +39-81-7464746
Received: September 28, 2013
Revised: December 13, 2013
Accepted: March 6, 2014
Published online: April 7, 2014
Abstract

In recent years, a number of case reports and clinical studies have highlighted the risk of hepatitis B and C virus reactivation in patients with inflammatory bowel disease who are treated with immunosuppressive drugs. The cases of viral hepatitis reactivation that have been reported are characterized by a wide range of clinical manifestations, from viremia without clinically relevant manifestations to fulminant life-threatening hepatitis. The development and dissemination of biological immunosuppressive drugs have led to a significant increase in the number of reports of interest to physicians in a variety of clinical settings. On this topic, there have been a number of published guidelines and reviews that have collected the available evidence, providing recommendations on prophylactic and therapeutic strategies and methods for monitoring patients at risk. However, it should be noted that, to date, very few clinical studies have been published, and most of the recommendations have been borrowed from other clinical settings. The published studies are mostly retrospective and are based on very heterogeneous populations, using different therapeutic and prophylactic regimens and obtaining conflicting results. Thus, it seems clear that it is desirable to concentrate our efforts on prospective studies, not conducting further reviews of the literature in the continued absence of new evidence.

Keywords: Inflammatory bowel disease, Biological agents, Hepatitis B virus reactivation, Hepatitis C virus reactivation, Prophylaxis

Core tip: Our review focused on the redundancy of papers on hepatitis B virus and hepatitis C virus reactivation in patients undergoing immunosuppressive therapy. However, we emphasize that, to date, very few clinical studies have been published, and most of them were retrospective with conflicting results. Thus, it is essential to conduct prospective studies before performing additional reviews of the literature.