Infliximab does not activate replication of lymphotropic herpesviruses in patients with refractory rheumatoid arthritis.
OBJECTIVE
The reactivation of human lymphotropic herpesviruses can be related to the intensity of immunosuppression. We analysed the risk of reactivation of lymphotropic herpesviruses in patients with refractory rheumatoid arthritis treated with an anti-tumour necrosis factor-alpha (TNF-alpha) agent (infliximab).


METHODS
Fifteen patients were treated with infliximab (3 mg/kg) at weeks 0, 2 and 6. Samples of both plasma and peripheral blood mononuclear cells (PBMC) were obtained before treatment (week 0) and before each infusion at weeks 2 and 6. Samples were analysed using a multiplex qualitative polymerase chain reaction (PCR) for lymphotropic herpesviruses. Quantification of cytomegalovirus (CMV) viral load (copies/ml) was performed using quantitative PCR. Reactivation was defined as the presence of viral DNA in plasma. Latent infection was defined as the presence of viral DNA in PBMC samples but not in plasma.


RESULTS
On baseline, latent CMV infection was detected in eight patients (53.3%), human herpesviruses-6 (HHV-6) in two (13.3%), Epstein-Barr virus (EBV) in seven (46.6%), CMV + HHV-6 in one (6.6%), CMV + EBV in two (13.3%) and HHV-6 + EBV in one (6.6%). Viral reactivation related to infliximab treatment was not observed. There was only one patient who had HHV-6 reactivation, but this was already detected in the baseline sample.


CONCLUSIONS
Infliximab treatment does not induce replication of human lymphotropic herpesviruses in patients with rheumatoid arthritis. Thus, herpesviruses prophylaxis would not be indicated in these patients.
Torre-Cisneros
J
J
Section of Infectious Diseases, Reina Sofía University Hospital, Córdoba, Spain. julian.torre.sspa@juntadeandalucia.es
Del Castillo
M
M
Castón
J J
JJ
Castro
M C
MC
Pérez
V
V
Collantes
E
E
D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000494:pharmacology*; D018501:Antirheumatic Agents / Q000494:pharmacology*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D015331:Cohort Studies; D004279:DNA, Viral / Q000097:blood; D005260:Female; D006564:Herpesviridae / Q000502:physiology*; D006801:Humans; D016867:Immunocompromised Host; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D014775:Virus Activation / Q000187:drug effects* / Q000276:immunology
D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D004279:DNA, Viral; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab