The impact of treatment with tumour necrosis factor-α antagonists on the course of chronic viral infections: a review of the literature

Abstract

Biologics that antagonize the biological activity of tumour necrosis factor (TNF)-alpha, namely infliximab, etanercept and adalimumab, are increasingly used for treatment of immune-mediated inflammatory diseases, including psoriasis, worldwide. TNF-alpha antagonists are known to increase the risk of reactivation and infection, particularly of infections with intracellular bacteria such as Mycobacterium tuberculosis. More frequently these agents are given to patients with viral infections. Viral hepatitis and human immunodeficiency virus infections are often present in these patients, with a considerable geographical variation. Other concomitant viral infections such as herpes, cytomegalovirus and varicella zoster virus may occur much more frequently than tuberculosis or leprosy. General recommendations about the management related to possible problems associated with anti-TNF-alpha treatment and these viral infections are lacking. This short review will give an overview of the most recent data available on the effects of anti-TNF-alpha therapy on viral infections with a particular focus on patient management and screening recommendations.

Molecular Biology, Epidemiology, and Pathogenesis of Progressive Multifocal Leukoencephalopathy, the JC Virus-Induced Demyelinating Disease of the Human Brain

“…Infliximab also induces apoptosis in TNF-␣-producing T cells (507,508). It has been associated with an increase in infections or reactivation of latent infections (120). This is probably due to a reduction in cellular immunity due to the blockage of TNF-␣ and T cell reduction.…”

Ustekinumab and Herpes Zoster

“…Indeed, increased susceptibility to viral diseases, including HZ, has been demonstrated [7,19,20,21,22,23,24,25,26,27,28,29]. Adalimumab and infliximab increase the risk of HZ by a twofold [29].…”

Treatment of Psoriasis with Efalizumab in Patients with Hepatitis C Viral Infection: Report of Five Cases

“…In contrast, anti-TNF-α therapy has recently been recognized to be associated with activation of HBV infection, with a potentially fatal outcome, mirroring experience in the setting of immune suppression and subsequent reconstitution in cancer chemotherapy and transplantation. Prophylactic or early intervention strategies with nucleoside analogs are recommended for patients with HBV infection as candidates for anti-TNF-α therapy [34]. Although further confirmation is needed, this report provides preliminary evidence to support a cautious use of efalizumab in patients with HCV infection at least in the short term.…”