Thursday, June 8, 2023
As an organization accredited by the ACCME, Medscape, LLC requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest.
Medscape, LLC encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.
Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio; R.J. Fasenmyer Chair of Clinical Immunology, Vice Chairman, Department of Rheumatic and Immunologic Diseases, Cleveland Clinic Foundation, Cleveland, Ohio
processing....
Purpose of review: A number of chronic viral infections could be reactivated by immunosuppressive agents used in rheumatic diseases. In this
review, we will focus on the complex effect of immunosuppressive agents, including biologic agents, on the natural course
of chronic viral infections as well as an approach to the prevention and management of therapy-induced viral reactivation.
Recent findings: Chronic viral infections that are affected by immunosuppression in the setting of an underlying rheumatic disease include
those due to hepatitis B virus, hepatitis C virus, or human immunodeficiency virus, and latent infections from Epstein-Barr
virus, JC virus, or varicella zoster virus. The most recent data of the effects of immunosuppressive agents are reviewed,
with special emphasis on the effects of biologic therapies (anti-tumor necrosis factor, anti-B cell), on these viral agents.
Summary: Clinicians should be aware of the risk for viral reactivation of an underlying chronic viral infection during immunosuppressive
therapy. Despite the existence of such risk, the presence of chronic viral infection is not a contraindication to immunosuppressive
therapy, given that appropriate pretherapy screening and close monitoring is applied.
Chronic viral infections in the setting of a rheumatic disease create a number of diagnostic and therapeutic dilemmas to the caring physician. In most cases, the main concern is the potential of immunosuppressive therapies to exacerbate an underlying viral infection with detrimental effects for the host. This concern is particularly relevant today, with the widespread use of biologic agents for the treatment of a variety of rheumatic diseases.[1] These include agents that target either pro-inflammatory cytokines such as tumor necrosis factor (TNF; infliximab, etanercept, adalimumab) or interleukin-1 (anakinra), immune cells such as B cells (rituximab), or costimulatory molecules (abatacept).
In this review, we will focus on specific chronic viral infections that can be affected by immunosuppressive therapies with a special emphasis on the role of biologic agents.
