How can coexistent HBV or HCV infection influence the treatment of rheumatic conditions?
Certain DMARDs such as methotrexate and leflunomide are hepatotoxic. The hepatotoxicity of these medications increases in patients who have HBV or HCV infection. Thus, methotrexate and leflunomide should be used with caution in HBV- or HCV-infected patients, if at all, and alternative DMARDs such as hydroxychloroquine, sulfasalazine, and azathioprine are preferred. Additional recommendations for the use of non-bDMARDs and bDMARDs in the setting of HBV infection are listed in Question #14. The use of TNF-α inhibitors in HCV patients appears to be safe.