This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Pharmacology
TNF–α inhibitors should not be used in : 
Select and explain. 
A. Rheumatoid arthritis with HIV infection, B. Rheumatoid arthritis with hepatitis B, C. Rheumatoid arthritis with hepatitis C, D. Rheumatoid arthritis with pulmonary fibrosis
B: Rheumatoid arthritis with hepatitis B
Answer: B: Rheumatoid arthritis with hepatitis B 
Explanation: Anti-TNF α drugs should be avoided in
Pulmonary tuberculosis
Multiple sclerosis
Hepatitis B
Congestive heart failure


Anti -TNF-α drugs like infliximab, etanercept and adalimumab are used in rheumatoid arthritis and increase the risk of bacterial infections. These can lead to reactivation of latent tuberculosis. Infliximab rarely, results in leucopenia, activation of hepatitis B and vasculitis.