Successful Etanercept Use in an HIV-Positive Patient With Rheumatoid Arthritis

Abstract

Limited information exists on treatment of rheumatoid arthritis in a patient with coexisting human immunodeficiency virus (HIV) infection. We report a case of a patient with rheumatoid arthritis who then became HIV positive. His HIV viral load was controlled with antiretroviral therapy, but he continued to have active rheumatoid arthritis despite therapy with hydroxychloroquine, sulfasalazine, and corticosteroids. Because of unremitting rheumatoid disease, we are now treating him with a TNFalpha inhibitor, and his rheumatoid disease activity has decreased from 28 swollen and tender joint count to less than 5.

Rheumatoid arthritis in patients with HIV: management challenges

“…In 2007, Kaur et al51 reported the use of a TNF-α inhibitor to treat RA in an individual with HIV infection. The patient had active synovitis and failed less immunosuppressive treatment with HCQ, intraarticular steroid injections, SSZ, and oral corticosteroids.…”

“…His HIV RNA peaked at 115 copies/mL while on therapy, his absolute CD4 T-cell count nadir was 236 cells/mm 3 . He had no adverse events with ongoing etanercept therapy 51. In 2007, Cepeda et al52 described two HIV-infected patients with RA treated with etanercept, both of whom had very low HIV RNA levels and CD4 T-cell counts >600 cells/mm 3 .…”

Manifestations ostéoarticulaires associées à l’infection par le VIH

“…De même, il a été observé que les traitements par anti-TNF alpha chez les patients suivis pour des spondyloarthropathies [50], polyarthrites rhumatoïdes, étaient très bien tolérés sur le plan virologique et sur les paramètres immunologiques. Non seulement ces traitements se sont révélés efficaces, mais le taux de CD4 est resté stable sans augmentation de la charge virale VIH [50][51][52][53].…”

Infections in the management of rheumatic diseases: An update

“…Data on the safety of immunosuppressive drugs in HIV-positive patients are limited, but there have been reports on the use of sDMARDs and TNF-α inhibitors to treat RA or other inflammatory conditions in HIV infection. [16,17] In general, these reports suggest that DMARDs such as methotrexate and anti-TNF are tolerated well by HIV-positive patients, provided that the patients are on an effective antiretroviral regimen before the start of therapy.…”