Hepatitis B virus infection or reactivation and HBV-related liver dysfunction in patients with inflammatory bowel disease receiving infliximab: a nationwide real-world study

Rongbei Liu; Tingting Wu; Jian Tang; Hongjie Zhang; Yanyun Fan; Haibo Sun; Chen Xie; Qunyan Zhou; Hongzhen Xu; Yabi Zhu; Mei Ye; Xiaomin Shi; Feng Tian; Haiyan Shen; Dan Xu; Ying Zhou; Qian Cao

doi:10.1007/s11684-026-1208-0

Hepatitis B virus infection or reactivation and HBV-related liver dysfunction in patients with inflammatory bowel disease receiving infliximab: a nationwide real-world study

MedScience. 2026 May 6. doi: 10.1007/s11684-026-1208-0. Online ahead of print.

Authors

Rongbei Liu^#^{1

2}, Tingting Wu^#^{3

4}, Jian Tang^{5

6}, Hongjie Zhang⁷, Yanyun Fan⁸, Haibo Sun⁹, Chen Xie¹⁰, Qunyan Zhou¹¹, Hongzhen Xu¹², Yabi Zhu¹³, Mei Ye¹⁴, Xiaomin Shi¹⁵, Feng Tian¹⁶, Haiyan Shen¹⁷, Dan Xu^{18

19}, Ying Zhou²⁰, Qian Cao^{21

22}

Affiliations

¹ Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, China. liurongbei@zju.edu.cn.
² Center of Inflammatory Bowel Disease, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, China. liurongbei@zju.edu.cn.
³ Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, China.
⁴ Center of Inflammatory Bowel Disease, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, China.
⁵ Department of Gastroenterology, Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510000, China.
⁶ Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangzhou, 510655, China.
⁷ Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
⁸ Department of Gastroenterology, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, 361004, China.
⁹ Department of Gastroenterology and Endoscopy Center, The First Hospital of Jilin University, Changchun, 130021, China.
¹⁰ Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China.
¹¹ Departments of Gastroenterology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi Medical Center, Nanjing Medical University, Wuxi, 214023, China.
¹² Department of Gastroenterology & Hepatology, West China Hospital, Sichuan University, Chengdu, 610044, China.
¹³ Department of Gastroenterology, Lishui People's Hospital, Lishui, 323006, China.
¹⁴ Department of Gastroenterology & Hepatology, Zhongnan Hospital of Wuhan University, Wuhan, 430062, China.
¹⁵ The Affiliated Hospital of Southwest Medical University, Chongqing, 404100, China.
¹⁶ 1st Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, 110072, China.
¹⁷ Department of Gastroenterology, The Second Hospital of Jiaxing, Jiaxing, 314099, China.
¹⁸ Department of Gastroenterology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China.
¹⁹ Key Laboratory for Molecular Diagnosis of Hubei Province, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China.
²⁰ Department of Gastroenterology, Ningbo Medical Center Lihuili Hospital, Ningbo, 315046, China.
²¹ Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, China. Caoq@zju.edu.cn.
²² Center of Inflammatory Bowel Disease, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, China. Caoq@zju.edu.cn.

^# Contributed equally.

PMID: 42087049
DOI: 10.1007/s11684-026-1208-0

Abstract

Infliximab (IFX) for inflammatory bowel disease (IBD) treatment may increase the risk of hepatitis B virus (HBV) reactivation, particularly in areas with high HBV prevalence such as China. This study aimed to evaluate HBV reactivation/infection, liver dysfunction, vaccination efficacy and strategies in IBD patients undergoing IFX therapy. This retrospective, multicenter study included 4183 IBD patients from 15 hospitals across China, who were divided into six groups according to the HBV status. Demographic features, HBV vaccination status, reactivation/infection rates, and liver dysfunction outcomes were collected, with data collection performed from 2009 to 2022. We found that HBV reactivation rate was notably higher in HBsAg positive group than other groups (P < 0.05) despite antiviral treatment. Although only 29% of patients were immunized at IFX initiation and almost no patients got vaccinated against HBV during IFX treatment, no patients experienced HBV infection in the susceptible population group. The study underscores a critical need for rigorous HBV screening before IFX initiation. Despite antiviral prophylaxis, the importance of continuous monitoring of HBV DNA is necessary for HBsAg positive patients. HBsAg negative patients, including the susceptible population, had a very low risk of new HBV infection, thus reassuring patients and physicians of the safety of IFX in this cohort.

Keywords: HBV; IBD; reactivation; vaccination.