The implications of anti-tumour necrosis factor therapy for viral infection in patients with inflammatory bowel disease.
BACKGROUND
Anti-tumour necrosis factor (TNF) therapy is increasingly used in the management of inflammatory bowel disease; however, concerns have been raised regarding risk of infection with such drugs. Little is known about their effect upon viral infection.


METHODS
A search of PubMed using the terms 'infliximab', 'etanercept', 'adalimumab' or 'anti-TNF therapy' combined with the names of specific viruses was performed. A search of cited papers was used to identify further relevant reports.


RESULTS
Numerous reports of the use of anti-TNF in patients with chronic or latent viral infection appear in the literature. Specific problems related to hepatitis B virus and varicella zoster virus may exist. The safety profile of anti-TNF in chronic viral infection is generally reassuring.


RESULTS
Numerous consensus statements relating to pre-treatment serology or vaccination have recently appeared; however, significant variation exists in their recommendations.


CONCLUSIONS
Increasing awareness of the implications of anti-TNF therapy on viral infection may allow safer use of such drugs.


CONCLUSIONS
The clinical and cost-effectiveness of screening for viral infections prior to anti-TNF requires further study.
Shale
Matthew J
MJ
Gastrointestinal Section, Imperial College London, Hammersmith Hospital Campus, London W12 0NN, UK. m.shale@imperial.ac.uk
D002908:Chronic Disease; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D015212:Inflammatory Bowel Diseases / Q000150:complications / Q000188:drug therapy*; D012008:Recurrence; D012306:Risk; D014409:Tumor Necrosis Factor-alpha / Q000009:adverse effects*; D014777:Virus Diseases / Q000209:etiology*
D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha