{"id":1884,"date":"2010-10-01T01:00:00","date_gmt":"2010-10-01T00:00:00","guid":{"rendered":"https:\/\/angh.net\/abstracts\/depistage-du-virus-de-lhepatite-b-vhb-chez-les-malades-suivis-pour-une-maladie-inflammatoire-cryptogenetique-de-lintestin-mici-etude-de-pratique-dans-les-hopitaux-generaux\/"},"modified":"2018-10-20T18:39:51","modified_gmt":"2018-10-20T16:39:51","slug":"depistage-du-virus-de-lhepatite-b-vhb-chez-les-malades-suivis-pour-une-maladie-inflammatoire-cryptogenetique-de-lintestin-mici-etude-de-pratique-dans-les-hopitaux-generaux","status":"publish","type":"post","link":"https:\/\/angh.net\/abstracts\/depistage-du-virus-de-lhepatite-b-vhb-chez-les-malades-suivis-pour-une-maladie-inflammatoire-cryptogenetique-de-lintestin-mici-etude-de-pratique-dans-les-hopitaux-generaux\/","title":{"rendered":"D\u00e9pistage du virus de l\u2019h\u00e9patite B (VHB) chez les malades suivis pour une maladie inflammatoire cryptog\u00e9n\u00e9tique de l\u2019intestin (MICI): \u00e9tude de pratique dans les H\u00f4pitaux g\u00e9n\u00e9raux"},"content":{"rendered":"

2010<\/strong><\/p>\n

C Poupardin (1), S Nahon (1), F Harnois (2), C Charpignon (3), JF Cadranel (4), J Denis (5), H Hag\u00e8ge (6), B Lesgourgues (1), C Renou (7), ANGH
\n(1) Montfermeil; (2) Lagny; (3) Villeneuve-Saint-Georges; (4) Creil; (5) Corbeil-Essonnes; (6) Cr\u00e9teil; (7) Hyeres<\/em><\/p>\n

Gastroent\u00e9rologie <\/strong>– \u00a02010-06-08 –\u00a0 –<\/p>\n

________________________________<\/p>\n

Plus de 50% des malades de la cohorte C\u00e9same (MICI) sont trait\u00e9s par immunosuppresseurs et\/ou bioth\u00e9rapie. R\u00e9cemment, l\u2019EASL et ECCO ont soulign\u00e9s l\u2019importance de la connaissance du statut du VHB avant d\u2019initier un traitement par immunosuppresseur ainsi que celle de prescrire un traitement pr\u00e9emptif en pr\u00e9sence d\u2019un AgHBs (1, 2). Le but de cette enqu\u00eate \u00e9tait d\u2019\u00e9valuer les pratiques des h\u00e9pato-gastroent\u00e9rologues de l\u2019ANGH vis-\u00e0-vis du VHB chez les malades atteints de MICI.
\nM\u00e9thodes : un questionnaire \u00e9tait adress\u00e9 \u00e0 l\u2019ensemble des membres actifs de l\u2019ANGH par courrier \u00e9lectronique. Les r\u00e9ponses \u00e9taient obtenues sur la base du volontariat \u00e0 l\u2019aide d\u2019un questionnaire informatis\u00e9 compos\u00e9 de questions \u00e0 choix simple et multiple.
\nR\u00e9sultats : quatre-vingt sept praticiens r\u00e9pondaient \u00e0 l\u2019ensemble des questions de cette enqu\u00eate. L\u2019activit\u00e9 des praticiens \u00e9tait gastroent\u00e9rologique dans 34% des cas, h\u00e9patologique dans 15% des cas et mixte dans 51% des cas. Les marqueurs du VHB \u00e9taient recherch\u00e9s dans 91% des cas, rarement d\u00e8s le diagnostic de MICI (28%) et plus fr\u00e9quemment avant le d\u00e9but du traitement par immunosuppresseurs (72%). Le d\u00e9pistage \u00e9tait majoritairement s\u00e9rologique (78%). Quarante-neuf pourcents des praticiens recommandaient syst\u00e9matiquement une vaccination des malades s\u00e9ron\u00e9gatifs alors que 35% d\u2019entre eux ne vaccinaient que les malades \u00e0 risque d\u2019infection virale. Le contr\u00f4le des anticorps anti-HBs \u00e9tait effectu\u00e9 dans 25% des cas apr\u00e8s vaccination.
\nUn traitement pr\u00e9emptif \u00e9tait propos\u00e9 dans 70% des cas chez les porteurs inactifs de l\u2019AgHBs (ADN VHB <2000UI\/L). Un dosage de l\u2019ADN du VHB \u00e9tait r\u00e9alis\u00e9 dans 75% des cas alors qu\u2019une recherche l\u2019Ag HBe \u00e9tait effectu\u00e9e dans 29% des cas chez les porteurs isol\u00e9s de l\u2019Ac anti HBc. Dans cette situation particuli\u00e8re, un traitement pr\u00e9emptif \u00e9tait propos\u00e9 dans 50% des cas lorsque l\u2019ADN viral \u00e9tait positif et dans 9% des cas s\u2019il \u00e9tait n\u00e9gatif.
\nLes traitements pr\u00e9emptifs instaur\u00e9s en monoth\u00e9rapie \u00e9taient la lamivudine (22%), le tenofovir (24.5%) et l\u2019entecavir (31%). Le traitement pr\u00e9emptif \u00e9tait interrompu 6 mois apr\u00e8s l\u2019arr\u00eat des immunosuppresseurs chez 65,5% des porteurs inactifs. Une r\u00e9activation virale B sous immunosuppresseurs a \u00e9t\u00e9 rapport\u00e9e par 23 % des praticiens.
\nConclusion : La pratique des h\u00e9pato-gastroent\u00e9rologues des h\u00f4pitaux g\u00e9n\u00e9raux est le plus souvent conforme aux recommandations vis-\u00e0-vis du VHB chez les malades MICI. Un bilan s\u00e9rologique pr\u00e9coce devrait permettre de vacciner les malades non immunis\u00e9s avant l\u2019instauration d\u2019un traitement immuno-suppresseur, bilan qui n\u2019est effectu\u00e9 que par un quart d\u2019entre eux. De plus, un traitement pr\u00e9emptif devrait \u00eatre syst\u00e9matiquement propos\u00e9 aux porteurs inactifs du VHB alors qu\u2019il n\u2019est instaur\u00e9 que dans 70% des cas.<\/p>\n","protected":false},"excerpt":{"rendered":"

2010 C Poupardin (1), S Nahon (1), F Harnois (2), C Charpignon (3), JF Cadranel (4), J Denis (5), H Hag\u00e8ge (6), B Lesgourgues (1), C Renou (7), ANGH (1) Montfermeil; (2) Lagny; (3) Villeneuve-Saint-Georges; (4) Creil; (5) Corbeil-Essonnes; (6) Cr\u00e9teil; (7) Hyeres Gastroent\u00e9rologie – \u00a02010-06-08 –\u00a0 – ________________________________ Plus de 50% des malades de […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[4],"tags":[21],"class_list":["post-1884","post","type-post","status-publish","format-standard","hentry","category-gastroenterologie","tag-21"],"yoast_head":"\nD\u00e9pistage du virus de l\u2019h\u00e9patite B (VHB) chez les malades suivis pour une maladie inflammatoire cryptog\u00e9n\u00e9tique de l\u2019intestin (MICI): \u00e9tude de pratique dans les H\u00f4pitaux g\u00e9n\u00e9raux - 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