Hepatitis B and C virus infections and anti-tumor necrosis factor-alpha therapy: guidelines for clinical approach.
Anti-tumor necrosis factor-alpha (TNF) therapy has recently been recognized to be associated with activation of hepatitis B virus (HBV) infection, with a potentially fatal outcome, mirroring experience in the setting of immune suppression and subsequent reconstitution in cancer chemotherapy and transplantation. Although there is no current evidence that anti-TNF therapy influences the natural history of hepatitis C virus (HCV) infection, the involvement of TNF in the pathogenesis of hepatic injury and extrapolation from other clinical situations heighten awareness of a potential conflict. Preventive strategies should be mandatory. These include screening of all patients for HBV and HCV infection prior to commencement of anti-TNF therapy, and active monitoring of aminotransferases and, for HBV, viral load during and for 3 months after therapy has terminated. Prophylactic or early intervention strategies with nucleoside analogs are recommended for patients with evidence of HBV infection.
Nathan
Debbie M
DM
Monash University Department of Medicine, Box Hill Hospital, Vic 3128, Australia.
Angus
Peter W
PW
Gibson
Peter R
PR
D000893:Anti-Inflammatory Agents / Q000009:adverse effects*; D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D017408:Guidelines as Topic; D006509:Hepatitis B / Q000276:immunology; D006526:Hepatitis C / Q000276:immunology; D006801:Humans; D007165:Immunosuppression Therapy; D007167:Immunotherapy / Q000009:adverse effects*; D000069285:Infliximab; D014409:Tumor Necrosis Factor-alpha / Q000276:immunology
D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab