Anti-TNF drugs in patients with hepatitis B or C virus infection: Safety and clinical management

Mauro Vigan, Elisabetta Degasperi, Alessio Aghemo, Pietro Lampertico, Massimo Colombo

Research output: Contribution to journalArticlepeer-review


Introduction: Drugs targeting TNF-α biological activity are increasingly used for the treatment of immune-mediated diseases, like rheumatoid arthritis, inflammatory bowel diseases and psoriasis. Since TNF-α is a mediator of the immune response against viral infections, use of TNF-α inhibitors in patients with concurrent HBV or HCV infection can promote viral reactivation and potentially fatal liver failure. Areas covered: This paper reviews TNF mechanisms of action in viral hepatitis B and C, recommendations for managing HBV and HCV-infected patients receiving treatment with anti-TNF drugs, safety and anti-TNF hepatotoxicity. Expert opinion: In hepatitis B surface antigen (HBsAg) carriers undergoing anti-TNF therapy, either anti-HBV treatment or prophylaxis is mandatory to prevent hepatitis reactivation, whereas HBsAg-negative antibody to hepatitis B core antigen (anti-HBc) seropositive patients require watchful monitoring, only. Conversely, in HCV-infected patients, TNF-α inhibition by specific drugs is safe and could be even beneficial, as TNF-α pathways are involved in perpetuating liver inflammation and fibrosis progression in HCV. HBV- or HCV-infected patients should be referred to a hepatologist for expert clinical management whenever antiviral therapy is deemed necessary or hepatitis reactivation occurs.

Original languageEnglish
Pages (from-to)193-207
Number of pages15
JournalExpert Opinion on Biological Therapy
Issue number2
Publication statusPublished - Feb 2012


  • Adalimumab
  • Anti-TNF-α
  • Etanercept
  • Hepatitis B virus
  • Hepatitis C virus
  • Hepatitis reactivation
  • Infliximab

ASJC Scopus subject areas

  • Pharmacology
  • Clinical Biochemistry
  • Drug Discovery


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