Reactivation of latent viruses after treatment with biological therapies
Anil Kumar Asthana,1 John Samuel Lubel2,3
1Department of Gastroenterology, The Alfred Hospital, Melbourne, 2Department of Gastroenterology and Hepatology, Eastern Health, 3Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
Abstract: Biological therapies are used extensively for malignant (eg, lymphoma) and autoimmune (eg, rheumatoid arthritis) conditions. These agents include anti-tumor necrosis factor antagonists, such as infliximab, and B-cell-depleting therapies, such as rituximab. In the past decade, there has been an explosion in the types and numbers of agents being used. One of the known risks with these agents is infection. In particular, there is increasing awareness regarding latent virus reactivation. This occurs when a latent virus is reactivated into its active replicative phase as a result of an internal or external trigger, such as immunosuppression. It is challenging, however, to quantitatively attribute the risk of reactivation to biological therapy alone because the underlying malignant or autoimmune condition could also be a contributing factor. There is well documented evidence regarding the reactivation of viruses such as hepatitis B virus and cytomegalovirus with drugs such as rituximab. Long-term data are lacking; such data are essential to guide risk stratification and chemoprophylaxis. Universally accepted viral screening guidelines prior to commencement of immunosuppression are lacking. As an example, the US Centers for Disease Control and Prevention have published recommendations regarding hepatitis B virus screening prior to commencing immunosuppression, but this action has not translated into universally accepted guidelines. Some of the other relevant viruses involved include cytomegalovirus, hepatitis C virus, varicella zoster virus, Epstein–Barr virus, and other members of the herpes family. This article reviews the current literature on the risk of latent viral reactivation with biological therapy, such as anti-tumor necrosis factor and anti-B-cell drugs, with an emphasis on autoimmune conditions.
Keywords: latent viruses, autoimmune conditions, biological therapies, reactivation
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