GI Section, Imperial College London, London, UK.
Aliment Pharmacol Ther. 2010 Jan;31(1):20-34. doi: 10.1111/j.1365-2036.2009.04112.x.
Anti-tumour necrosis factor (TNF) therapy is now well established in the treatment of inflammatory bowel disease and the risk of opportunistic infection is recognized. However, specific considerations regarding screening, detection, prevention and treatment of chronic viral infections in the context of anti-TNF therapy in inflammatory bowel disease are not widely adopted in practice.
To provide a detailed and comprehensive review of the relevance of chronic viral infections in the context of anti-TNF therapy in inflammatory bowel disease.
Literature search was conducted using Medline, Pubmed and Embase using the terms viral infection, hepatitis, herpes, CMV, EBV, HPV, anti-TNF, infliximab, adalimumab, certolizumab pegol and etanercept. Hepatitis B and C and HIV had the largest literature associated and these have been summarized in Tables.
Particular risks are associated with the use of anti-TNF drugs in patients with hepatitis B infection, in whom reactivation is common unless anti-viral prophylaxis is used. Reactivation of herpes zoster is the most common viral problem associated with anti-TNF treatment, and may be particularly severe. Primary varicella infection may present with atypical features in patients on anti-TNF.
Appreciation of risks of chronic viral disease associated with anti-TNF therapy may permit early recognition, prophylaxis and treatment.
肿瘤坏死因子（TNF）拮抗剂疗法目前已广泛应用于炎症性肠病的治疗，其发生机会性感染的风险也已得到认识。然而，在炎症性肠病的 TNF 拮抗剂治疗中，对于慢性病毒感染的筛查、检测、预防和治疗，具体考虑因素并未广泛应用于临床实践中。
详细全面地综述慢性病毒感染与炎症性肠病 TNF 拮抗剂治疗的相关性。
使用 Medline、Pubmed 和 Embase 数据库，检索术语“viral infection（病毒感染）”“hepatitis（肝炎）”“herpes（疱疹）”“CMV（巨细胞病毒）”“EBV（EB 病毒）”“HPV（人乳头瘤病毒）”“anti-TNF（肿瘤坏死因子拮抗剂）”“infliximab（英夫利昔单抗）”“adalimumab（阿达木单抗）”“certolizumab pegol（培塞利珠单抗）”和“etanercept（依那西普）”，对相关文献进行检索。乙型肝炎和丙型肝炎及 HIV 的相关文献最多，已总结在表格中。
在乙型肝炎感染患者中使用 TNF 拮抗剂药物时，存在特殊风险，除非使用抗病毒预防措施，否则通常会发生病毒再激活。疱疹病毒再激活是与 TNF 拮抗剂治疗最相关的常见病毒问题，且可能特别严重。在使用 TNF 拮抗剂的患者中，原发性水痘感染可能表现为不典型特征。
了解与 TNF 拮抗剂治疗相关的慢性病毒疾病的风险，可能有助于早期识别、预防和治疗。
