title: Anti-TNF drugs in patients with hepatitis B or C virus infection: safety and clinical management.
abstract: BACKGROUND
  Drugs targeting TNF-α biological activity are increasingly used for the treatment of immune-mediated diseases, like rheumatoid arthritis, inflammatory bowel diseases and psoriasis. Since TNF-α is a mediator of the immune response against viral infections, use of TNF-α inhibitors in patients with concurrent HBV or HCV infection can promote viral reactivation and potentially fatal liver failure.
  
  
  METHODS
  This paper reviews TNF mechanisms of action in viral hepatitis B and C, recommendations for managing HBV and HCV-infected patients receiving treatment with anti-TNF drugs, safety and anti-TNF hepatotoxicity.
  
  
  CONCLUSIONS
  In hepatitis B surface antigen (HBsAg) carriers undergoing anti-TNF therapy, either anti-HBV treatment or prophylaxis is mandatory to prevent hepatitis reactivation, whereas HBsAg-negative antibody to hepatitis B core antigen (anti-HBc) seropositive patients require watchful monitoring, only. Conversely, in HCV-infected patients, TNF-α inhibition by specific drugs is safe and could be even beneficial, as TNF-α pathways are involved in perpetuating liver inflammation and fibrosis progression in HCV. HBV- or HCV-infected patients should be referred to a hepatologist for expert clinical management whenever antiviral therapy is deemed necessary or hepatitis reactivation occurs.
authors.affiliation: San Giuseppe Hospital, Hepatology Unit, Milan, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Viganò
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Degasperi
authors.forename: Alessio
authors.initials: A
authors.lastname: Aghemo
authors.forename: Pietro
authors.initials: P
authors.lastname: Lampertico
authors.forename: Massimo
authors.initials: M
authors.lastname: Colombo
mesh_terms: D000068879:Adalimumab; D000818:Animals; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects / Q000627:therapeutic use; D056486:Chemical and Drug Induced Liver Injury / Q000453:epidemiology / Q000517:prevention & control; D019468:Disease Management; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology / Q000517:prevention & control; D000068800:Etanercept; D006509:Hepatitis B / Q000276:immunology / Q000378:metabolism / Q000628:therapy*; D006526:Hepatitis C / Q000276:immunology / Q000378:metabolism / Q000628:therapy*; D006801:Humans; D007074:Immunoglobulin G / Q000009:adverse effects / Q000627:therapeutic use; D061214:Patient Safety / Q000592:standards; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000276:immunology* / Q000378:metabolism
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D000068879:Adalimumab; D000068800:Etanercept