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Safety of antitumour necrosis factor (anti-TNF) therapy in patients with chronic viral infections: hepatitis C, hepatitis B, and HIV infection

L H Calabrese¹, N Zein², D Vassilopoulos³

¹ Department of Rheumatic and Immunologic Disease, Cleveland Clinic Foundation, Cleveland, Ohio, USA
² Department of Gastroenterology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
³ Hippokration General Hospital, Athens University School of Medicine, Athens, Greece

Correspondence to:
Correspondence to:
L H Calabrese
Department of Rheumatic and Immunologic Disease, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland Ohio 44195; calabrl{at}ccf.org

Tumour necrosis factor (TNF) is a pivotal cytokine in host defences with broad ranging effects on the innate and adaptive immune systems. Clinically, TNF inhibitors have demonstrated remarkable efficacy in a wide range of autoimmune and inflammatory disorders but clearly at the cost of heightened susceptibility to a variety of infections in those treated with these agents. Most reports to date have described increased susceptibility to intracellular pathogens in patients with underlying chronic viral infections, but little in the way of adverse event reporting in these patients has occurred. While the reported experience to date is rather limited, TNF inhibitors have displayed a reasonable safety profile in the setting of some chronic viral infections and in certain circumstances have demonstrated adjunctive activity in the treatment of these infections. Given the high prevalence of chronic viral infections in patients who are candidates for anti-TNF therapy and the potential for these agents in the treatment of chronic viral illness, additional studies are urgently needed to assess the risks and benefits of such therapy in these populations.

Abbreviations: ALT, alanine aminotransferase; CTL, cytotoxic T lymphocyte; HAART, highly active antiretroviral therapy; HBV, hepatitis B virus; HCC, hepatocellular carcinoma; HCV, hepatitis C virus; HIV, human immunodeficiency virus; NHANES, National Health and Nutrition Examination; SVR, sustained viral response; TNF, tumour necrosis factor

Keywords: tumour necrosis factor; hepatitis C; hepatitis B; human immunodeficiency virus; HIV

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