Hepatitis B and C virus infections and anti-tumor necrosis factor-alpha therapy: guidelines for clinical approach

J Gastroenterol Hepatol. 2006 Sep;21(9):1366-71. doi: 10.1111/j.1440-1746.2006.04559.x.


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.

Publication types

  • Review

MeSH terms

  • Anti-Inflammatory Agents / adverse effects*
  • Antibodies, Monoclonal / adverse effects*
  • Guidelines as Topic
  • Hepatitis B* / immunology
  • Hepatitis C* / immunology
  • Humans
  • Immunosuppression Therapy
  • Immunotherapy / adverse effects*
  • Infliximab
  • Tumor Necrosis Factor-alpha / immunology


  • Anti-Inflammatory Agents
  • Antibodies, Monoclonal
  • Tumor Necrosis Factor-alpha
  • Infliximab