alexa Reactivation of Hepatitis B Virus Infection Associated with Anti-Tumor Necrosis Factor-α Therapy
ISSN: 1948-5964

Journal of Antivirals & Antiretrovirals
Open Access

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Review Article

Reactivation of Hepatitis B Virus Infection Associated with Anti-Tumor Necrosis Factor-α Therapy

Lorenzo Nobili, Lisa Albani, Armando Gabrielli and Gianluca Moroncini*

Department of Molecular and Clinical Sciences, Marche Polytechnic University, Ancona, 60126 Italy; and Clinica Medica, Ospedali Riuniti Ancona, Ancona, 60126 Italy

These authors contributed equally to this article

*Corresponding Author:
Gianluca Moroncini
Department of Molecular and Clinical Sciences
Marche Polytechnic University, Ancona, 60126 Italy; and Clinica Medica
Ospedali Riuniti Ancona, Ancona, 60126 Italy
Tel: +39 071 220 6247
E-mail: [email protected]

Received Date: April 28, 2014; Accepted Date: August 29, 2014; Published Date: August 31, 2014

Citation: Nobili L, Albani L, Gabrielli A, Moroncini G (2014) Reactivation of Hepatitis B Virus Infection Associated with Anti-Tumor Necrosis Factor-a Therapy. J Antivir Antiretrovir 6:092-101. doi: 10.4172/jaa.10000104

Copyright: 2014 Nobili L, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.



The use of TNF-α inhibitors, nowadays widely employed as first choice drugs for the therapy of chronic inflammatory diseases such as Rheumatoid Arthritis (RA), Psoriatic Arthritis (PA), and Inflammatory Bowel Diseases (IBD), may be associated to reactivation of HBV infection. In this review we summarized the case reports/series and prospective/retrospective studies focusing on this topic, and analyzed the guidelines of the major scientific societies dealing with this problem. Reactivation may occur mainly in HBV inactive carriers positive for HBsAg; the likelihood of reactivation is lower in HBsAg positive subjects with low DNA level (<2000 UI/L) and rare in HBsAg negative patients. Anti-TNF-α candidate patients should be screened for HBV serum markers. On the basis of HBV serology, it is possible to suggest different therapeutic strategies. In patients with chronic hepatitis B infection it is necessary to start an appropriated antiviral therapy and adequate follow-up. Inactive HBsAg carriers must be treated with HBV prophylactic agents. Patients with resolved hepatitis B should be tightly monitored for elevation of liver enzymes and HBV DNA levels. All HBV negative patients should receive vaccination before starting anti-TNF-α treatment.


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