title: The long-term effects of anti-TNF-α agents on patients with chronic viral hepatitis C and B infections.
abstract: OBJECTIVE
  To evaluate the long-term effects of anti-tumor necrosis factor-alpha (TNF-α) therapy on patients with chronic hepatitis B and C infections.
  
  
  METHODS
  Rheumatoid arthritis, ankylosing spondylitis and Crohn's disease patients administered anti-TNF-α therapy for at least 36 months were retrospectively reviewed for hepatitis B or C serology, liver function tests, viral load, genotype and liver biopsy results, if performed. Nine relevant cases receiving anti-TNF-α were evaluated: six patients had chronic hepatitis C, one had chronic dual hepatitis B and C and two had chronic hepatitis B infection.
  
  
  RESULTS
  The patient with dual infection exhibited virologic breakthrough for hepatitis C and required treatment. Two patients with occult hepatitis B infection developed hepatitis B surface antigen (HBsAg) reversion and low-level viremia at the end of the study.
  
  
  CONCLUSIONS
  Long-term use of anti-TNF-α treatments may result in viral replication that requires anti-viral therapy. Before determining the safety of anti-TNF drugs in the treatment of autoimmune diseases in patients with hepatitis C infection, studies with large homogeneous patient groups must be performed, and the exact group of hepatitis C virus infected patients for whom anti-TNF treatment would be deemed safe should be identified. Prior to anti-TNF-α treatment, it seems logical to screen all patients for HBsAg and anti-HB core immunoglobulin G status, especially in endemic regions. These patients must be followed periodically by means of alanine aminotransferase, HBsAg and hepatitis B virus DNA to identify HBsAg reversion and active viral replication that might require anti-viral prophylaxis or treatment.
authors.affiliation: Division of Gastroenterology, Faculty of Medicine, Department of Internal Medicine, Eskişehir Osmangazi University, Eskisehir, Turkey.
authors.forename: Tuncer
authors.initials: T
authors.lastname: Temel
authors.forename: Döndü Üsküdar
authors.initials: DÜ
authors.lastname: Cansu
authors.forename: Cengiz
authors.initials: C
authors.lastname: Korkmaz
authors.forename: Timuçin
authors.initials: T
authors.lastname: Kaşifoğlu
authors.forename: Ayşegül
authors.initials: A
authors.lastname: Özakyol
mesh_terms: D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000998:Antiviral Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D015415:Biomarkers / Q000097:blood; D003424:Crohn Disease / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D005260:Female; D016174:Hepacivirus / Q000254:growth & development / Q000276:immunology; D006515:Hepatitis B virus / Q000254:growth & development / Q000276:immunology; D019694:Hepatitis B, Chronic / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology*; D019698:Hepatitis C, Chronic / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology*; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D013167:Spondylitis, Ankylosing / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D013997:Time Factors; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000276:immunology; D014779:Virus Replication
chemical_list: D000893:Anti-Inflammatory Agents; D000998:Antiviral Agents; D015415:Biomarkers; D014409:Tumor Necrosis Factor-alpha
keywords: anti-TNF-α treatment; autoimmune disease; chronic viral hepatitis