The implications of anti-tumour necrosis factor therapy for viral infection in patients with inflammatory bowel disease

Abstract

Introduction: Anti-tumour necrosis factor (TNF) therapy is increasingly used in the management of inflammatory bowel disease; however, concerns have been raised regarding risk of infection with such drugs. Little is known about their effect upon viral infection.

Sources of data: A search of PubMed using the terms 'infliximab', 'etanercept', 'adalimumab' or 'anti-TNF therapy' combined with the names of specific viruses was performed. A search of cited papers was used to identify further relevant reports.

Areas of agreement: Numerous reports of the use of anti-TNF in patients with chronic or latent viral infection appear in the literature. Specific problems related to hepatitis B virus and varicella zoster virus may exist. The safety profile of anti-TNF in chronic viral infection is generally reassuring.

Areas of controversy: Numerous consensus statements relating to pre-treatment serology or vaccination have recently appeared; however, significant variation exists in their recommendations.

Growing points: Increasing awareness of the implications of anti-TNF therapy on viral infection may allow safer use of such drugs.

Areas timely for developing research: The clinical and cost-effectiveness of screening for viral infections prior to anti-TNF requires further study.