mercaptopurine and Hepatitis-B--Chronic

We aimed to determine the prevalence of chronic and past hepatitis B virus (HBV) infection in Chinese patients with inflammatory bowel disease (IBD), and to determine the risk factors associated with having received no vaccination for HBV and abnormal liver function among our patients.. The prevalence of chronic or past infection with HBV infection and effective HBV vaccination were determined in patients with IBD who attended the IBD Clinic of the Queen Mary Hospital in Hong Kong, China. Risk factors associated with the absence of HBV vaccination and abnormal liver function were identified.. A total of 267 Chinese IBD patients (166 ulcerative colitis and 101 Crohn's disease) were enrolled. The mean follow-up period was 10.5 years. Chronic and past HBV infection was detected in 6.7% and 28.5% patients, respectively. Altogether 102 patients lacked effective HBV vaccination. Multivariate analysis found that elder age at diagnosis of IBD (OR 1.02, 95% CI 1.00-0.94) and the absence of using thiopurine (OR 0.53, 95% CI 0.29-0.94) were associated with the presence of anti-HBs. Abnormal liver function was detected in 27 (10.1%) patients. The use of anti-tumor necrosis factor agents (OR 4.6, 95% CI 1.3-16.0), previous bowel resection (OR 3.7, 95% CI 1.5-9.2) and male gender (OR 4.4, 95% CI 1.4-13.7) were significant risk factors for abnormal liver function.. The use of thiopurine and younger age at diagnosis were associated with no vaccination against HBV in Chinese IBD patients. Chronic or past HBV infection was, however, not associated with abnormal liver function in these patients.

Topics: Adult; Age Factors; Aged; Alanine Transaminase; Female; Follow-Up Studies; Hepatitis B Antibodies; Hepatitis B Surface Antigens; Hepatitis B Vaccines; Hepatitis B, Chronic; Humans; Immunosuppressive Agents; Inflammatory Bowel Diseases; Liver; Male; Mercaptopurine; Middle Aged; Risk Factors; Vaccination

Viral hepatitis is a cause of hepatic dysfunction in children with ALL in remission during maintenance therapy is debated. The aims of the current study were (1) to explore the incidence of hepatic dysfunction in a group of children (Egyptian and Saudi) with ALL under maintenance therapy, (2) to study the prevalence of hepatitis B (HBV) and/or C (HCV) infection and their contributions to chronic liver disease that might be induced by maintenance therapy.. The current study included 105 children with ALL (54 Egyptian and 51 Saudi). All eligible patients had been on maintenance therapy for at least 12 months and all had serial assessments of liver function. These included determination of total bilirubin, AST, ALT, and alkaline phosphatase. Markers for HBV and HCV including HBsAg, anti-HBC, and anti-HCV and for some patients HCV RNA by PCR were studied. Percutaneous liver biopsy was performed for a group of children.. The prevalence of hepatitis infection (HBV and/or HCV) among Egyptian children was found to be high (43/54-80%). Only five Saudi children had evidence of exposure to HBV (5/51-9.8%), P<0.0001. During the period of study, 22 Egyptian patients vs. four Saudi patients (41 vs. 7.8%, P<0.0001) experienced at least one episode of elevation of liver enzymes, three times the upper limit of normal or more. Twenty-six of the 48 patients (54%) with HBV and/or HCV infection had episodes of elevated liver enzymes, while there was no occurrence among the patients negative for HBV and HCV. In patients with HBV infection, the presence of HBsAg was strongly associated (100%) with elevated liver enzymes. Histopathologic examination of liver biopsies obtained from 35 patients revealed that all five patients negative for HBV and HCV had normal liver biopsies in spite of being under maintenance therapy.. In children undergoing treatment for ALL, elevations in liver enzymes may be primarily due to hepatitis viruses. However, maintenance therapy using known hepatotoxic drugs, may have additive deleterious effects. Liver enzymes are normalized in affected patients when maintenance therapy is temporarily suspended.

Topics: Antimetabolites, Antineoplastic; Case-Control Studies; Chemical and Drug Induced Liver Injury; Child; Egypt; Hepatitis B, Chronic; Hepatitis C, Chronic; Humans; Incidence; Mercaptopurine; Methotrexate; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Prospective Studies; Saudi Arabia