Journal
BRITISH MEDICAL BULLETIN
Volume 92, Issue 1, Pages 61-77Publisher
OXFORD UNIV PRESS
DOI: 10.1093/bmb/ldp036
Keywords
anti-TNF; viral infection; hepatitis B virus; varicella zoster virus
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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. 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. 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. Numerous consensus statements relating to pre-treatment serology or vaccination have recently appeared; however, significant variation exists in their recommendations. Increasing awareness of the implications of anti-TNF therapy on viral infection may allow safer use of such drugs. The clinical and cost-effectiveness of screening for viral infections prior to anti-TNF requires further study.
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