RA with Hepatitis B??? We are still not sure of the answer. Anti TNF-a drugs can be used in all of the conditions mentioned in the question. Anti TNF a the therapy in Hepatitis B For the treatment of HBV, Anti TNF- atherapy showed cases of fulminant HBV reactivation. But any HBV reactivation was treated success fully with lamivudine therapy, thus it was concluded that physicians should consider antiviral therapy in patients with HBV (with or without active viral replication) and initiated treatment should continue for 3-6 months after stopping anti TNF- therapy. Both published British society of Rheumatology guidelines and British society of Gastroenterology guidelines concludes:- Successful treatment of active RA with anti TNF a in patients chronically infected with HBV is possible and can be safe. Our findings together with those of others, suggest that chronic HBV infection need not preclude therapy with anti TNF a where clinically indicated but an individualized approach is required including careful counseling, collaboration with colleagues in gastroenterology and intensive monitoring. HIV and anti TNF- a therapy As of now there are only eight patients treated with HIV and Rheumatoid disease. Retrospective series of eight patients suggests that treatment with anti TNF- a therapy can be used in HIV patients without advanced disease with associated rheumatic diseases. HCV and anti TNF-- cc therapy Anti TNF- a therapy is safe in patients with HCV and Rheumatoid ahritis. In a study involving 31 patients with RA with concomitant HCV infection, TNF a blocker seemed to be safe provided there is close monitoring of clinical virological data. Pulmonary fibrosis and anti TNF- a therapy Anti TNF-a therapy is considered safe in patients with Rheumatoid ahritis and pulmonary fibrosis. In some cases pulmonary. fibrosis seems to have improved with anti-TNF- atherapy.