Epstein-Barr Virus Infection in Inflammatory Bowel Disease Patients: Its Relationship with Immunosuppressive Therapy, Liver Dysfunction, and Oncogenic Risk Markers in Kirkuk City, Iraq

Abstract

Background: Epstein-Barr Virus (EBV) is the first identified human oncogenic virus and has been increasingly linked to the pathogenesis of inflammatory bowel disease (IBD), particularly in patients undergoing immunosuppressive therapy. The virus is believed to contribute to disease worsening and liver dysfunction in this vulnerable population. Objective: This study aimed to assess the prevalence of EBV infection among patients with IBD and to explore its potential association with immunosuppressive treatments and liver enzyme abnormalities. Methods: Case-control study was conducted involving 100 IBD patients (56 with ulcerative colitis and 44 with Crohn’s disease) and 100 healthy controls. Serum samples were analyzed for EBV VCA IgM, VCA IgG, and EBNA-1 IgG using ELISA. Liver function tests (ALT, AST, TSB, ALP, and GGT) were performed. EBV DNA was detected using real-time polymerase chain reaction (PCR). Results: EBV seropositivity was significantly higher in IBD patients (UC: 76.7%; CD: 70.4%) compared to controls (6%) (p < 0.0001). EBV DNA was detected in 22% of IBD patients. The highest rates of positivity were observed among those receiving azathioprine (UC: 94%, CD: 90%). Abnormal liver enzyme levels were strongly associated with EBV positivity, particularly elevated ALT, AST, and TSB in both UC and CD groups. Conclusion: These findings suggest a possible link between EBV infection, immunosuppressive therapy, and hepatic dysfunction in IBD patients. Screening for EBV before initiating immunosuppressive treatment may be beneficial in managing potential complications.