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  • Review Article
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Tumor necrosis factor blockade and the risk of viral infection

Nature Reviews Rheumatology volume 6, pages 165–174 (2010)Cite this article

Subjects

Abstract

Tumor necrosis factor (TNF) blockers are widely used to treat rheumatoid arthritis and other chronic inflammatory diseases. Many studies have demonstrated an increased risk of opportunistic infections such as tuberculosis and fungal infection in patients treated with TNF blockers, which is thought to be related to the primary role of TNF both in host defense and in the immune response. Little is known, however, about the association between TNF blockade and the development of viral infection. Owing to the critical role of TNF in the control of viral infection, depletion of this cytokine with TNF blockers could facilitate the development or reactivation of viral infection. A number of large observational studies have found an increased risk of herpes zoster in patients receiving TNF blockers for the treatment of rheumatoid arthritis. This Review draws attention to the risk of several viral infections, including HIV, varicella zoster virus, Epstein–Barr virus, cytomegalovirus, and human papillomavirus, in patients receiving TNF-blocking therapy for chronic inflammatory conditions. In addition, implications for clinical practice and possible preventative approaches are discussed.

Key Points

  • Little is known about the risk of viral infections associated with the use of tumor necrosis factor (TNF) blockers

  • Inhibition of TNF might facilitate the development or reactivation of viral infection through several mechanisms

  • Multiple cases of successful TNF-blocking therapy in HIV-infected patients are described in the literature

  • Although uncommon, infection with various viruses such as varicella-zoster virus, Epstein–Barr virus, cytomegalovirus, human papillomavirus and JC virus has been reported following TNF-blocking therapy

  • The effects of TNF blockade on the long-term sequelae of viral infection such as cancer and latent infectious illnesses might not yet be fully appreciated

  • Clinicians should be aware of the current guidelines for adult immunizations with vaccines that can prevent viral infection

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  1. Division of Rheumatology, and Division of Pharmacoepidemiology and Pharmacoeconomics, Immunology, and Allergy, Brigham and Women's Hospital, 75 Francis Street, Boston, 02115, MA, USA

    Seo Young Kim & Daniel H. Solomon

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  1. Seo Young Kim
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Correspondence to Seo Young Kim.

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Competing interests

D. H. Solomon has received grants/research support from Amgen and Abbott. S. Y. Kim declares no competing interests.

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Kim, S., Solomon, D. Tumor necrosis factor blockade and the risk of viral infection. Nat Rev Rheumatol 6, 165–174 (2010). https://doi.org/10.1038/nrrheum.2009.279

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