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

• Published in: British journal of dermatology (1951) Vol. 159; no. 6; pp. 1217 - 1228
• Main Authors: Domm, S., Cinatl, J., Mrowietz, U.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01-12-2008
• Subjects: Antiviral Agents - therapeutic use; Cytomegalovirus; Female; hepatitis; herpes; Human immunodeficiency virus; Humans; Immune System Diseases - complications; Immune System Diseases - drug therapy; Immunosuppressive Agents - adverse effects; Inflammation - drug therapy; Male; Mycobacterium tuberculosis; TNF-α antagonists; Tumor Necrosis Factor-alpha - antagonists & inhibitors; Varicella-zoster virus; viral infection; Virus Diseases - etiology
• ISSN: 0007-0963; 1365-2133
• DOI: 10.1111/j.1365-2133.2008.08851.x

Summary
Biologics that antagonize the biological activity of tumour necrosis factor (TNF)‐α, namely infliximab, etanercept and adalimumab, are increasingly used for treatment of immune‐mediated inflammatory diseases, including psoriasis, worldwide. TNF‐α 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‐α 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‐α therapy on viral infections with a particular focus on patient management and screening recommendations.