Antiviral Prophylaxis in Infliximab Therapy

Hepatitis B Virus Prophylaxis

The American Gastroenterological Association recommends that all patients must be screened for HBsAg and anti-HBc before initiating infliximab, with testing including HBsAg, anti-HBc, and anti-HBs to determine infection status 1, 2
HBsAg-positive patients have a 12-39% risk of HBV reactivation with infliximab, and should start entecavir or tenofovir ideally 2 weeks before infliximab initiation, regardless of HBV DNA level 2, 3
The American College of Gastroenterology recommends continuing antiviral prophylaxis during infliximab therapy and for at least 12 months after cessation 3, 4
For HBsAg-negative/anti-HBc-positive patients, either administer prophylaxis or monitor HBV DNA copies every 3 months 1, 2

The National Comprehensive Cancer Network recommends antiviral prophylaxis with acyclovir or valacyclovir when infliximab is combined with alemtuzumab, bortezomib, purine analogues, or high-dose corticosteroids 3, 5, 6
Acyclovir 400 mg twice daily or valacyclovir 500 mg once daily is recommended for HSV prophylaxis, with higher doses required for VZV coverage: acyclovir 800 mg twice daily or valacyclovir 500 mg twice daily 5

The American College of Clinical Oncology recommends PJP prophylaxis should be considered only if infliximab is combined with prolonged corticosteroids, using trimethoprim-sulfamethoxazole as first-line prophylaxis 3, 6

The American College of Clinical Oncology strongly recommends annual inactivated quadrivalent influenza vaccine for all patients receiving infliximab, with optimal timing ≥7 days after last infliximab dose or ≥2 weeks before starting therapy 3

The American Thoracic Society recommends all patients must undergo TB screening before infliximab initiation, including clinical history, chest radiograph, and tuberculin skin testing, with most TB cases occurring within the first 12 weeks of treatment 7
The National Comprehensive Cancer Network recommends maintaining clinical awareness for TB development for 6 months after cessation of infliximab therapy 7