Tuberculosis and other infections in the anti-tumour necrosis factor-alpha (anti-TNF-α) era

We review the global experience of infections in patients treated with tumour necrosis factor (TNF)-α inhibitors, which shows that the overall incidence of severe infections is at least doubled. In particular, this is true regarding tuberculosis. Screening and prophylactic measures have substantially reduced but not eliminated the risk. Recent improvements in immunologic testing for non-Bacillus Calmette–Guerin (BCG)-related antigens allow more sensitive identification of latent tuberculosis and wider use of such methods holds promise as pre-treatment screening instruments.