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

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.