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Treatment of viral hepatitis with interferon-based therapies carries the risk of exacerbating underlying autoimmune disorders.1 Tumour necrosis factor alpha (TNFα) inhibitors are widely used in patients with rheumatic diseases, but anti-TNFα treatment may be associated with the reactivation of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection.2 3 Current treatment guidelines on rheumatological diseases,4 chronic HBV5 or HCV6 do not address the possibility of the concomitant administration of interferon and TNFα inhibitors in patients with both rheumatic disease and viral hepatitis.
A 37-year-old man presented to our clinic with a history of HLA-B27-positive psoriatic arthritis and chronic HBV–HCV (genotype 3a) co-infection, with HCV dominance (HCV-RNA 1.88×106 IU/ml, HBV-DNA <12 IU/ml; Roche COBAS TaqMan; Roche, Germany) and hepatitis B e antigen negativity.7 Liver biopsy …
Competing interests IM and HW received research funding and honoraria from Abbott, Roche and Schering-Plough, TW and DMO from Abbott, Bristol-Myers Squibb, Roche, UCB and Wyeth/Pfizer.
Provenance and peer review Not commissioned; externally peer reviewed.