Abstract:

Ulcerative colitis (UC) is a chronic inflammatory disorder of the large intestine which represents with constant exacerbations and remissions. Few of these patients also have a chronic Hepatitis ‘B’ (HBV) or chronic Hepatitis ‘C’ (HCV) infection. Treatment of moderate and severe forms of UC requires immunosuppression, whilst interferon therapy for HBV- and HCV-infections stimulates the immune system.Case Description: Four patients with UC were included. One with HBV-infection (male) and three had HCV-infection (2 males and 1 female). Patients were treated with specific antiviral therapy, as well as, with immunosuppressant medications (Corticosteroids and Azatioprine) for UC. Patient with chronic HBV-infection: had severe UC with frequent exacerbation. Despite that Pegylated Interferon alfa was initiated and UC exacerbation followed. Lamivudine was conducted and when viral replication was undetectable immunosuppression was restarted. Remission of UC was achieved. Patients with chronic HCV-infection: one of them was with mild UC, the other two were with a severe form of the disease. In all of the patients, first of all stable remission of the UC was achieved, afterwards they were all treated for HCV-infection with Pegylated Interferon and Ribavirin. During the antiviral treatment the UC did not exacerbated in any of the patients. Conclusions:1. Before starting interferon treatment in patients with UC who have HBV and HCV-infection, remission of the UC must be achieved;2.Nucleotide/side analogues in chronic HBV-infection allow rigorous immunosuppressive treatment of UC;3. All HBsAg(+) positive patients with UC, regardless of their replication rate, who will undergo immunosuppressive therapy must be treated with Nucleotide/side analogues.