Hepatitis B and C reactivation with tumor necrosis factor inhibitors: synopsis and interpretation of screening and prophylaxis recommendations

Isr Med Assoc J. 2013 Jun;15(6):303-7.

Abstract

Information on reactivation of chronic viral hepatitis infection in patients who are candidates for tumor necrosis factor alpha inhibitors (TNFi) is in a constant state of flux. We retrieved the most updated guidelines (in English) of prominent rheumatological and gastroenterological professional socienties for the mangement of chronic hepatitis B (HBV) and hepatitis C virus (HCV) infection in the context of treatment with TNFi. Subsequently, the major areas of uncertainty and absence of consensus in the guidelines were located and a secondary search for additional studies addressing those areas was performed. Based on our search we formulated a personal interpretation applicable to health care settings with virological laboratories capable of performing viral load measurements, and health systems that can support use of potent nucleoside/tide analogues in well-defined patient populations.

Publication types

  • Review

MeSH terms

  • Clinical Protocols / standards
  • Crohn Disease / drug therapy*
  • Hepacivirus / physiology
  • Hepatitis B virus / physiology
  • Hepatitis B, Chronic / diagnosis*
  • Hepatitis B, Chronic / therapy
  • Hepatitis B, Chronic / virology
  • Hepatitis C, Chronic / diagnosis*
  • Hepatitis C, Chronic / therapy
  • Hepatitis C, Chronic / virology
  • Humans
  • Immunologic Factors / therapeutic use
  • Mass Screening / methods
  • Mass Screening / organization & administration
  • Practice Guidelines as Topic
  • Rheumatic Diseases / drug therapy*
  • Secondary Prevention
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors*
  • Viral Load / methods
  • Virus Activation / drug effects*

Substances

  • Immunologic Factors
  • Tumor Necrosis Factor-alpha