medwireNews: Tumor necrosis factor (TNF) inhibitors have good long-term effectiveness and are well tolerated in HIV-positive individuals with rheumatic diseases, researchers report.
John Reveille (University of Texas, Houston, USA) and colleagues explain that although TNF inhibitors and other biologics are commonly used in rheumatology practice, “their usage in HIV-1 patients has been met with concern given that anti-TNF therapy increases susceptibility to infections.”
The team evaluated data from 17 HIV-positive patients with psoriatic arthritis (29.4%), peripheral spondyloarthritis (29.4%), axial spondyloarthritis (23.5%), or rheumatoid arthritis (17.7%) from a single center. These people had an inadequate response to conventional therapy, CD4 counts of more than 200 cells/μL, and a HIV viral load of less than 60,000 copies/mm3, and initiated a TNF inhibitor in 2003–2021. Five individuals were on TNF inhibitors for more than 10 years, while four switched from a TNF inhibitor to another biologic or a Janus kinase inhibitor without complications.
In all, 70.5% of the cohort experienced a “good to excellent clinical response to biological therapy with near total symptomatic remission,” say the study authors. A further 23.5% had a partial or transient response, while just one patient had “no perceived benefit” from TNF inhibitor treatment, they add.
The majority (82.4%) of patients were on combination antiretroviral therapy for HIV. The most recent average CD4 cell count was 1013.7 cells/µL, and none of the patients experienced counts below 200.0 cells/μL.
Reveille et al report that there were no cases of infection requiring hospitalization and discontinuation of medication while patients were on biologic therapy. Adverse events during biologic treatment were reported in 35.3% of the cohort, including herpetic lesions and anterior acute uveitis in patients on etanercept, and an allergy to secukinumab leading to a switch to ustekinumab.
Taken together, these findings suggest that biologics “provide a means for achieving symptomatic remission without major adverse opportunistic infections or any detrimental effects on CD4 counts or viral load,” write the authors in RMD Open.
They conclude that “if a patient’s HIV-1 infection is well controlled and the patient not significantly immunocompromised, biological agents can be considered as a viable option for treating a variety of rheumatic diseases.”
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