Anti-TNF Therapy “Viable Alternative” for Rheumatic Disease in HIV Patients

NEW YORK (Reuters Health) May 13 - HIV-positive individuals with rheumatic disease can be effectively treated with anti-tumor necrosis factor (TNF) agents, according to a report in the May issue of the Annals of the Rheumatic Diseases.

“As long as guidelines are followed, autoimmune and autoinflammatory diseases occurring in the setting of HIV infection can be treated with standard therapies used in the non-HIV setting,” Dr. John D. Reveille from The University of Texas-Houston Health Science Center told Reuters Health.

Dr. Reveille and colleagues analyzed the safety and efficacy of treatment of various rheumatic conditions with etanercept and/or infliximab in a retrospective, open-label, case series of eight HIV-positive patients whose rheumatic diseases were not responsive to conventional therapy.

There were two patients with rheumatoid arthritis, three with psoriatic arthritis, and one each with undifferentiated spondyloarthritis, reactive arthritis, and ankylosing spondylitis.

“As the caregiver of these patients who had to deal with active, progressive disease that was in many worsening in the face of immune reconstitution with HAART therapy, I had to make therapeutic decisions based on my own experience and what information was available at the time I began using anti-TNF agents in this clinic,” Dr. Reveille explained.

“At that time (early 2003) there were two published case reports and a personal communication from one of the companies making anti-TNF inhibitors that these agents were probably safe as long as the guidelines for the use of immunosuppressive agents in the setting of HIV infection were used.”

“Nevertheless, the potential for anti-TNF agents to cause other infections was carefully discussed with each patient before we would begin them,” Dr. Reveille added. “We did use a uniform protocol to make sure that nothing would be overlooked in these patients getting anti-TNF agents while we followed them.”

Six of the eight patients had an excellent response with near total symptomatic remission, one had a sustained partial response, and the patient with ankylosing spondylitis had only a transient improvement of his back pain, the authors report.

No patient experienced clinical deterioration or progression of HIV disease during up to 48 months of follow-up, and there were no opportunistic infections, malignancies, or cases of active tuberculosis during this period.

Anti-TNF therapy had no adverse impact on CD4 cell counts or HIV viral load, the investigators say, except in one patient who required temporary discontinuation of treatment after a substantial increase in his HIV viral load after initiation of infliximab therapy. This did not recur with subsequent infusions.

This series “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,” the team concludes.

Source:

1. Anti-TNF Therapy “Viable Alternative” for Rheumatic Disease in HIV Patients