Epstein-Barr Virus Status and Subsequent Thiopurine Exposure Within a Pediatric Inflammatory Bowel Disease Population

J Pediatr Gastroenterol Nutr. 2021 Sep 1;73(3):358-362. doi: 10.1097/MPG.0000000000003197.

Rachel E Harris 1, Vikas Hegde 2, Lee Curtis 3, Vikki Garrick 3, Lisa Gervais 3, Lawrence Armstrong 4, Caroline Delahunty 5, Andrew Eccleston 6, Ghassan Al-Hourani 7, Diana M Flynn 3, Victoria Merrick 8, Andrew R Barclay 3, Rachel Tayler 3, Richard Hansen 3, Richard K Russell 8


Author information

  • 1Department of Paediatrics, Sheffield Children's Hospital, Sheffield.
  • 2School of Medicine, University of Glasgow.
  • 3Department of Paediatric Gastroenterology, Hepatology and Nutrition, Royal Hospital for Children, Glasgow.
  • 4Department of Paediatrics, University Hospital Crosshouse, Kilmarnock.
  • 5Department of Paediatrics, Wishaw General Hospital, Lanarkshire.
  • 6Department of Paediatrics, Dumfries and Galloway Royal Infirmary, Dumfries.
  • 7Department of Paediatrics, Forth Valley Royal Hospital, Larbert.
  • 8Department of Paediatric Gastroenterology and Nutrition, Royal Hospital for Sick Children, Edinburgh, UK.


The use of thiopurine therapy in Epstein-Barr virus (EBV)-naïve inflammatory bowel disease (IBD) patients remains controversial due to a risk of EBV-associated complications. We evaluated EBV status and outcomes within our paediatric IBD population over an 8-year period; finding that 217 of 409 (53%) screened patients were seropositive for EBV at IBD diagnosis; that thiopurines were used in 189 of 217 (87%) seropositive and 159 of 192 (83%) seronegative patients (P = 0.22); and that 7 of 192 (4%) previously seronegative patients subsequently tested positive for EBV with 6 of 7 (86%) patients having concurrently recorded thiopurine use. All six patients continued thiopurine with/without a period of cessation; no EBV-associated lymphoproliferative disorders/serious complications were recorded within our cohort. A significant proportion of our patients would not receive thiopurine therapy should their use be avoided in EBV-negative patients (47%) or seronegative males (30%). The small but significant risks of thiopurine treatment must be balanced against the potential benefits of successful IBD management; further research into this is required.

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