December 13, 2013

Tumor necrosis factor-α inhibitors and chronic hepatitis C: A comprehensive literature review

World J Gastroenterol. 2013 Nov 28;19(44):7867-7873.

Pompili M, Biolato M, Miele L, Grieco A.

Maurizio Pompili, Marco Biolato, Luca Miele, Antonio Grieco, Department of Internal Medicine, Università Cattolica del Sacro Cuore, 8-00168 Roma, Italy.


Tumor necrosis factor-α (TNF-α) inhibitors are known to increase reactivation of concurrent chronic hepatitis B, but their impact on the hepatitis C virus (HCV) is controversial. Some conditions of immunosuppression, such as liver transplantation, typically cause an increase in the rate of HCV evolution. Inhibition of TNF-α, a cytokine involved in the apoptotic signaling pathway of hepatocytes infected by HCV, could potentially increase viral replication. Currently available clinical data appear to contradict this hypothesis. A review of medical literature revealed that a total of 216 patients with HCV were exposed to one or more treatments with TNF-α inhibitors, with a median observation time of 1.2 years and 260 cumulative patient-years of exposure. Only three cases of drug withdrawal due to suspected HCV liver disease recrudescence were reported. Treatment with TNF-α inhibitors in patients with HCV infection appears to be safe in the short term, but there are insufficient data to assess their long-term safety. Universal screening for HCV before beginning treatment with TNF-α inhibitors is currently controversial. The presence of HCV is not a contraindication to therapy with TNF-α inhibitors, with the exception of cirrhotic patients. In cases of cirrhosis, the benefit/risk ratio should be evaluated at the individual level. Prior to treatment with TNF-α inhibitors, patients with HCV should be referred to a hepatologist to determine the necessity of hepatic disease assessment, using liver biopsy or non-invasive methods, and the potential indication for antiviral therapy. In patients with HCV infection who are treated with TNF-α inhibitors, liver function monitoring every three months is advised.


Adalimumab, Etanercept, Hepatitis C virus, Inflammatory bowel disease, Infliximab, Psoriasis, Rheumatoid arthritis

PMID: 24307780 [PubMed - as supplied by publisher] PMCID: PMC3848134


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