Journal
JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY
Volume 21, Issue 9, Pages 1366-1371Publisher
WILEY
DOI: 10.1111/j.1440-1746.2006.04559.x
Keywords
ankylosing spondylitis; hepatitis; inflammatory bowel disease; reactivation; rheumatoid arthritis; tumor necrosis factor
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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.
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