HBV感染后的再激发

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Reactivation of Chronic HBV INFECTION

Occurrence after infliximab therapy for Crohn's disease.  Infliximab is the current standard therapy for patients with fistulizing Crohn's disease that is unresponsive to conventional treatment.  The use of infliximab is contraindicated in the presence of active infection, and recommendations have been issued concerning the prevention and treatment of bacterial and opportunistic infections prior to the initiation of infliximab infusions.  However, little is known about the effects of this immunomodulatory agent on the course of patients with chronic viral hepatitis, and there are no recommendations for the surveillance and treatment of HBV infection before infliximab infusions.  Recently 2 cases of severe or fulminant hepatitis B related to infliximab treatment have been reported in patients with rheumatic diseases.  In the current article, M. Esteve and associates report the reactivation of HBV in 2 patients with Crohn's disease treated with infliximab.  The authors prospectively determined hepatitis markers and liver function tests in 80 Crohn's disease patients treated with infliximab in 3 hospitals in Spain.  Chronic HBV infection was identified in 3 patients.  Two of these patients developed a severe reactivation of hepatitis B following the withdrawal of infliximab and 1 patient died.  The third patient was treated with lamivudine at the time of infliximab therapy and had no clinical or biochemical evidence of liver disease.  HBV vaccination was given to 6 other patients, and no changes in hepatic function were detected in these patients.  This report indicates the need for screening Crohn's disease patients who require infliximab therapy for HBV infection.  The authors recommend antiviral therapy for HBsAg-positive patients who are to receive infliximab treatment and HBV vaccination for patients without natural immunity to HBV at the diagnosis of Crohn's disease.  (Esteve M, et al. Gut 2004; 53:1363-1365)