Gut Liver.  2022 May;16(3):396-403. 10.5009/gnl210081.

Clinical Course of Hepatitis B Viral Infection in Patients Undergoing Anti-Tumor Necrosis Factor α Therapy for Inflammatory Bowel Disease

  • 1Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
  • 2Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
  • 3Department of Gastroenterology and Inflammatory Bowel Disease Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
  • 4Department of Internal Medicine, First Affiliated Hospital, Sun Yat-sen University, Shanghai, China
  • 5Department of Internal Medicine and Institute of Lifelong Health, Yonsei University Wonju College of Medicine, Wonju, Korea
  • 6Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
  • 7Department of Gastroenterology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
  • 8Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
  • 9Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
  • 10Department of Internal Medicine, Toho University Sakura Medical Center, Sakura, Japan


Little is known about the clinical course of hepatitis B virus (HBV)-infected patients undergoing anti-tumor necrosis factor α (TNF-α) therapy for inflammatory bowel disease (IBD). We aimed to investigate the clinical course of HBV infection and IBD and to analyze liver dysfunction risks in patients undergoing anti-TNF-α therapy.
This retrospective multinational study involved multiple centers in Korea, China, Tai-wan, and Japan. We enrolled IBD patients with chronic or resolved HBV infection, who received anti-TNF-α therapy. The patients’ medical records were reviewed, and data were collected using a web-based case report form.
Overall, 191 patients (77 ulcerative colitis and 114 Crohn’s disease) were included, 28.3% of whom received prophylactic antivirals. During a median follow-up duration of 32.4 months, 7.3% of patients experienced liver dysfunction due to HBV reactivation. Among patients with chronic HBV infection, the proportion experiencing liver dysfunction was significantly higher in the non-prophylaxis group (26% vs 8%, p=0.02). Liver dysfunction occurred in one patient with resolved HBV infection. Antiviral prophylaxis was independently associated with an 84% reduction in liver dysfunction risk in patients with chronic HBV infection (odds ratio, 0.16; 95% confidence interval, 0.04 to 0.66; p=0.01). The clinical course of IBD was not associated with liver dysfunction or the administration of antiviral prophylaxis.
Liver dysfunction due to HBV reactivation can occur in HBV-infected IBD patients treated with anti-TNF-α agents. Careful monitoring is needed in these patients, and antivirals should be administered, especially to those with chronic HBV infection.


Hepatitis B virus; Reactivation; Inflammatory bowel disease; Anti-tumor necrosis factor alpha
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