Tuğçe EŞKAZAN, Abdullah SONSUZ
Cerrahpaşa Medical Journal - 2026;50(1):1-4
Objective: Chronic hepatitis B virus (HBV) infection poses a risk of viral reactivation in patients receiving immunosuppressive therapies, including anti-tumor necrosis factor (TNF) agents. This study aimed to evaluate HBV screening practices, antiviral prophylaxis, and reactivation outcomes in patients with inflammatory bowel disease (IBD) undergoing biologic therapy at a tertiary referral center in Turkey. Methods: Patients diagnosed with IBD who initiated biologic therapy between 2009 and 2025 were retrospectively reviewed. Demographic and clinical characteristics, HBV serologic status, antiviral prophylaxis, vaccination history, and HBV reactivation events were recorded. Chronic HBV infection was defined as persistent hepatitis B surface antigen (HBsAg) positivity for more than 6 months. Occult HBV infection was defined as HBsAg negativity with anti-HBc positivity and detectable HBV DNA. HBV reactivation was defined as the reappearance of HBV DNA or HBsAg in patients with previously undetectable levels, or a greater than 10-fold increase in HBV DNA, in accordance with EASL 2025 criteria. Results: A total of 437 patients were included (59% male; mean age 33.2 +/- 12.8 years), of whom 72% had Crohn's disease. Anti-HBc positivity was detected in 70 patients (16%). Five patients (1.1%) were HBsAg positive, and 1 patient had occult HBV infection; all 6 received antiviral therapy. Overall, 12 patients (2.7%) received antiviral prophylaxis. During a mean biologic exposure of 33.5 +/- 28.6 months, no HBV reactivation occurred in patients receiving or not receiving antiviral therapy. HBV vaccination was documented in 25.8% of patients, with loss of vaccine-acquired immunity observed in 18.5%. Among patients with natural immunity, 15.1% experienced anti-HBs seroreversion. Conclusion: Real-life data from this tertiary IBD center demonstrate appropriate HBV screening and antiviral prophylaxis in high-risk patients. The absence of HBV reactivation supports close monitoring rather than routine prophylaxis in intermediate-risk groups. Periodic reassessment of HBV serology is recommended due to antibody loss during immunosuppressive therapy.
