Research allays concerns over TNF inhibitor use in HIV-positive patients
medwireNews: Study findings presented at the ACR Convergence 2021 virtual meeting support the use of tumor necrosis factor (TNF) inhibitor therapy in patients with HIV infection.
Study presenter Benjamin Naovarat (University of Texas McGovern Medical School, Houston, USA) explained that “the primary concerns for TNF [inhibitor] therapy arise from increased susceptibility to infections, especially mycobacterium, atypical mycobacteria, and other organisms.”
However, in his team’s study of 16 patients with rheumatic conditions treated with TNF inhibitors, including seven treated between 2003 and 2006, there were no major infectious episodes that necessitated discontinuation of medications.
The study participants were aged an average of 43 years and spondyloarthritis was the most common rheumatic condition, affecting 37.5% of patients, followed by psoriatic arthritis (31.3%), rheumatoid arthritis (18.8%), and reactive arthritis (12.5%).
The majority of patients were taking antiretroviral therapy (ART), at 87.5%, and the lowest CD4 count, on average, was 642 cells/µL.
Naovarat reported that during the 18 years of follow-up none of the patients in the original cohort had a CD4 count that dropped below 200 cells/µL and “for the most part, patients had an undetectable viral load.”
He noted that even among two patients from the original cohort who switched to the biologics ustekinumab and tocilizumab, there were no adverse side effects.
“For the most part, patients had an excellent response to anti-TNF therapy with no side effects and no infection that was documented,” Naovarat highlighted. This included the patients who were not taking ART.
Just three patients discontinued TNF inhibitor therapy – one due to a lack of efficacy, one due to rising HIV viral load, and one due to fear of toxicity, although no toxicity occurred.
Provided that a patient is not immunocompromised, “these agents that we prescribe for various rheumatic diseases […] are well tolerated without any adverse side effects from CD4 count or HIV viral load and patients demonstrated remarkable and excellent response to these agents,” Naovarat concluded.
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