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World J Gastroenterol. Nov 28, 2013; 19(44): 7867-7873
Published online Nov 28, 2013. doi: 10.3748/wjg.v19.i44.7867
Tumor necrosis factor-α inhibitors and chronic hepatitis C: A comprehensive literature review
Maurizio Pompili, Marco Biolato, Luca Miele, Antonio Grieco
Maurizio Pompili, Marco Biolato, Luca Miele, Antonio Grieco, Department of Internal Medicine, Università Cattolica del Sacro Cuore, 8-00168 Roma, Italy
Author contributions: Pompili M and Biolato M designed the study, wrote the manuscript, and revised the final version of the article; Miele L and Grieco A contributed to the literature search and writing the manuscript.
Correspondence to: Maurizio Pompili, MD, Department of Internal Medicine, Università Cattolica del Sacro Cuore, Largo A Gemelli, 8-00168 Roma, Italy. mpompili@rm.unicatt.it
Telephone: +39-6-30154334 Fax: +39-6-35502775
Received: September 27, 2013
Revised: October 31, 2013
Accepted: November 12, 2013
Published online: November 28, 2013
Processing time: 74 Days and 19 Hours
Abstract

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.

Keywords: Infliximab; Etanercept; Adalimumab; Hepatitis C virus; Rheumatoid arthritis; Inflammatory bowel disease; Psoriasis

Core tip: Our review summarizes data on patients with hepatitis C exposed to tumor necrosis factor-α (TNF-α) inhibitors, thus building a stronger safety profile than previously reported. A comprehensive paragraph on the pathway of TNF-α in hepatitis C virus (HCV) and an overview on immune-mediated damage induced by TNF-α inhibitors (cryoglobulins, autoimmune hepatitis) have been also included. Some controversies regarding the universal screening and monitoring of HCV-RNA were also addressed.