RESEARCH - The use of anti-TNF therapy in HIV-positive individuals with rheumatic disease

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Ann Rheum Dis. 2008 May;67(5):710-2. Epub 2007 Dec 13.

The use of anti-tumour necrosis factor therapy in HIV-positive

individuals with rheumatic disease.

Cepeda EJ, FM, Ishimori ML, Weisman MH, Reveille JD.

The University of Texas-Houston Health Science Center, MSB 5.270, 6431

Fannin, Houston, TX 77030, USA.

OBJECTIVE: The purpose of this study was to examine the safety and

efficacy of anti-tumour necrosis factor (TNF) agents (etanercept,

infliximab and adalimumab) in HIV-positive patients with rheumatic

diseases refractory to standard therapy.

METHODS: Patients were treated with anti-TNF blocker with rheumatic

diseases refractory to disease modifying antirheumatic drugs who had a

CD4 count of >200 mm3 and an HIV viral load of <60 000 copies/mm3 and

no active concurrent infections. Changes in CD4 counts, HIV viral

loads, or other adverse effects while on anti-TNF agents and clinical

response were monitored for 28.1 (SD 20.9) months (range 2.5-55).

RESULTS: Eight HIV-positive patients were treated with anti-TNF

blockers (two patients with rheumatoid arthritis, three with psoriatic

arthritis, one with undifferentiated spondyloarthritis, one with

reactive arthritis and one with ankylosing spondylitis). No

significant clinical adverse effect was attributed to this treatment

in any patient. CD4 counts and HIV viral load levels remained stable

in all patients. Three patients on etanercept therapy and two patients

on infliximab had sustained clinical improvement in their rheumatic

diseases.

CONCLUSIONS: This retrospective series of eight patients suggests that

treatment with anti-TNF-alpha therapy is a viable alternative in HIV

patients without advanced disease with associated rheumatic diseases

refractory to standard therapy.

PMID: 18079191

http://www.ncbi.nlm.nih.gov/pubmed/18079191

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