title: Tumor necrosis factor-α inhibitors and chronic hepatitis C: a comprehensive literature review.
abstract: Tumor necrosis factor-α (TNF-α) inhibitors are known to increase reactivation of concurrent chronic hepatitis B, but their impact on the hepatitis C virus (HCV) is controversial. Some conditions of immunosuppression, such as liver transplantation, typically cause an increase in the rate of HCV evolution. Inhibition of TNF-α, a cytokine involved in the apoptotic signaling pathway of hepatocytes infected by HCV, could potentially increase viral replication. Currently available clinical data appear to contradict this hypothesis. A review of medical literature revealed that a total of 216 patients with HCV were exposed to one or more treatments with TNF-α inhibitors, with a median observation time of 1.2 years and 260 cumulative patient-years of exposure. Only three cases of drug withdrawal due to suspected HCV liver disease recrudescence were reported. Treatment with TNF-α inhibitors in patients with HCV infection appears to be safe in the short term, but there are insufficient data to assess their long-term safety. Universal screening for HCV before beginning treatment with TNF-α inhibitors is currently controversial. The presence of HCV is not a contraindication to therapy with TNF-α inhibitors, with the exception of cirrhotic patients. In cases of cirrhosis, the benefit/risk ratio should be evaluated at the individual level. Prior to treatment with TNF-α inhibitors, patients with HCV should be referred to a hepatologist to determine the necessity of hepatic disease assessment, using liver biopsy or non-invasive methods, and the potential indication for antiviral therapy. In patients with HCV infection who are treated with TNF-α inhibitors, liver function monitoring every three months is advised.
authors.affiliation: Maurizio Pompili, Marco Biolato, Luca Miele, Antonio Grieco, Department of Internal Medicine, Università Cattolica del Sacro Cuore, 8-00168 Roma, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Pompili
authors.forename: Marco
authors.initials: M
authors.lastname: Biolato
authors.forename: Luca
authors.initials: L
authors.lastname: Miele
authors.forename: Antonio
authors.initials: A
authors.lastname: Grieco
mesh_terms: D000818:Animals; D000998:Antiviral Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016903:Drug Monitoring; D016174:Hepacivirus / Q000187:drug effects*; D019698:Hepatitis C, Chronic / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D012307:Risk Factors; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000378:metabolism
chemical_list: D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha
keywords: Adalimumab; Etanercept; Hepatitis C virus; Inflammatory bowel disease; Infliximab; Psoriasis; Rheumatoid arthritis