Herpes virus, human papilloma virus and polyomavirus infection in patients undergoing biological therapy

Biological therapy has redesigned the treatment of certain systemic inflammatory disorders, and it is currently employed in clinical practice by specialties such as rheumatology, dermatology, gastroenterology, neurology and oncology. A decade’s worth of data has classified biological therapy as safe and effective for the treatment of a large number of diseases. However, its associated risk of secondary infections remains a major issue, particularly when discussing long-term immunosuppressive treatment. Secondary viral infections can require delaying or discontinuing biological therapy, thus leading to a relapse or reactivation of the underlying disorder, and this can happen in patients with already limited therapeutic options. Thorough screening and timely diagnosis of viral reactivations are necessary in order to maximize the benefits and reduce the risks associated with biological therapy. Viruses frequently associated with such reactivations include hepatitis B and C viruses, cytomegalovirus, varicella-zoster virus, and Epstein-Barr virus. This review focuses on the risk of reactivation associated with biological therapy in patients with autoimmune diseases and underlying herpes virus, human papilloma virus and polyomavirus infections.