P689 Multicenter, cross-sectional, observational study on Epstein–Barr viral infection status and thiopurine use by age group in patients with inflammatory bowel disease in Japan

Abstract

Abstract Background The Epstein–Barr virus (EBV) infection status in patients with inflammatory bowel disease (IBD), particularly those using thiopurines, may be associated with the risk of lymphoproliferative disorder and hemophagocytic lymphohistiocytosis. This was the first multicenter survey of EBV infection in Japanese patients with IBD (UMIN000033004). Factors related to the EBV infection status were also investigated. Methods This cross-sectional observational study of the EBV infection status in pediatric and adult patients with IBD was conducted at five tertiary institutions in Japan. Serum EBV anti-viral capsid antigen (VCA) IgG, and EBV anti-VCA IgM were measured in 495 patients with IBD□(UC:313 patients, CD:174 patients, IBD-U:8 patients). Patient characteristics (sex, age at diagnosis, age at onset, duration of illness, and disease location), treatments, and blood examination results were obtained from the medical records at each institution. Prior EBV infection was defined as anti-VCA IgM negativity and anti-VCA IgG positivity. Results mong the 495 patients, 56.2% (278/495) were male, and the median age at diagnosis of IBD was 18 years. The median age at the time of the anti-VCA IgG examination was 25 years(range: 0–92 years). Of the 495 patients, 9 were anti-VCA IgM-positive and 354 were anti-VCA IgG-positive (seroprevalence: 72.8%). The proportion of patients with prior EBV infection was 0% for those aged <5 years, <60% for those aged <30 years, and >90% for those aged >30 years. The patients’ current thiopurine use was 37.8% (187/486) for all anti-VCA IgM negative patients and 42.3% (85/201) for anti-VCA IgM negative patients aged <20 years. The proportion of EBV-uninfected patients using thiopurines was 28.4% (52/183) for all patients and 51.8% (44/85) for aged <20 years. Age was significantly associated with anti-VCA IgG seropositivity (p < 0.01, odds ratio: 0.902, 95% confidence interval: 0.880–0.925). No cases of lymphoproliferative disorder, hemophagocytic lymphohistiocytosis, or chronic active EBV infection were reported. Conclusion Approximately 30% of Japanese patients with IBD were EBV-uninfected, including those using thiopurines. Age was a significant factor for anti-VCA IgG seropositivity.