Ann Rheum Dis 63:ii18-ii24 doi:10.1136/ard.2004.028209
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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

  1. L H Calabrese1,
  2. N Zein2,
  3. D Vassilopoulos3
  1. 1Department of Rheumatic and Immunologic Disease, Cleveland Clinic Foundation, Cleveland, Ohio, USA
  2. 2Department of Gastroenterology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
  3. 3Hippokration General Hospital, Athens University School of Medicine, Athens, Greece
  1. Correspondence to:
    L H Calabrese
    Department of Rheumatic and Immunologic Disease, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland Ohio 44195;


    Tumour necrosis factor α (TNFα) is a pivotal cytokine in host defences with broad ranging effects on the innate and adaptive immune systems. Clinically, TNFα 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, TNFα 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.