Which additional infection screening may be considered before initiating TNF inhibitors if indicated?

• A. Hepatitis B
• B. Hepatitis C
• C. HIV
• D. Malaria

Answer: (A)

TNF inhibitors suppress a key part of the immune response, which can allow latent infections to flare up. Hepatitis B is the infection most clearly at risk of reactivation when TNF-α is blocked, potentially causing serious hepatitis. Because of this, screening for hepatitis B is commonly recommended before starting TNF inhibitors. This involves testing for markers such as HBsAg, anti-HBc, and anti-HBs to identify current infection, past exposure, or immunity. If evidence of active or prior HBV infection is found, appropriate steps—like antiviral prophylaxis or vaccination in those without immunity—may be needed before or during TNF inhibitor therapy.

Hepatitis C and HIV are important baseline considerations in many patients, but the strongest, most direct concern with TNF inhibitors is HBV reactivation. Malaria isn’t a typical consideration in this context. So hepatitis B screening stands out as the most relevant infection check prior to initiating TNF inhibitors.