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