Azathioprine can be safely used in HIV-infected individuals

Chamberlain, Florence; Dinani, N.; Singh, Gurmeet; Bower, Mark; Nelson, Mark

doi:10.1097/qad.0000000000000121

Cited by 16 publications

(9 citation statements)

References 4 publications

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“…There is no previous data to suggest such an increased risk. There is lack of good studies but available case report and series have shown that anti-TNF agents and azathioprine can be used safely in HIV patients (18,19). The increased risk can be possibly explained by inability to mount significant host T cell response by HIV infected cells along with use of immunosuppressive drugs for IBD treatment.…”

Section: Discussionmentioning

confidence: 99%

Trends and outcomes of fungal infections in hospitalized patients of inflammatory bowel disease: a nationwide analysis

Mushtaq¹,

Khan²,

Aziz³

et al. 2020

Transl Gastroenterol Hepatol

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Background: Immunosuppressive therapy is being increasingly used in the management of inflammatory bowel disease (IBD) which comprises of ulcerative colitis (UC) and Crohn's disease (CD). Patients on immunosuppressive therapy are at increased risk of developing opportunistic fungal infections. We conducted this analysis to describe the epidemiology of opportunistic fungal infections in this cohort. Methods: We analyzed the National Inpatient Sample (NIS) database for all subjects with discharge diagnosis of IBD (UC and Crohn's disease) & Fungal infections (Histoplasmosis, Pneumocystosis, Cryptococcosis, Aspergillosis, Blastomycosis, candidiasis, Coccidioidomycosis) as primary or secondary diagnosis via ICD 9 codes during the period from 2002-2014. Results: In UC, the incidence of all fungal infections was more in age above 50 (except for pneumoconiosis) male gender (except Candidiasis) and in Caucasians. In CD, the incidence was more in age above 50 (except Pneumocystosis, Blastomycosis & Coccidioidomycosis), female gender (except Histoplasmosis, Pneumocystosis & Cryptococcosis) and in Caucasians. Histoplasmosis and Blastomycosis were more prevalent in Midwest, Cryptococcosis and Candidiasis in South, Coccidioidomycosis in west in both UC and CD. Age above 50, south region, HIV, Congestive heart failure, underlying malignancies, diabetes mellitus with complications, chronic pulmonary disease, anemia, rheumatoid arthritis, collagen vascular disease, pulmonary circulation disorders, weight loss were significant predictors of fungal infections in IBD. The yearly trend showed a consistent small rise in incidence, and the mortality dropped till 2006 to peak again in 2008 with a subsequent decline.Conclusions: Our study is the first one to describe the basic demographics features and characteristics of opportunistic fungal infections in hospitalized patients with IBD. The yearly incidence of fungal infections did not show a significant rise. The mortality increased between 2006-2008 and a significant difference remains between IBD patients with and without fungal infections. One explanation of rise in mortality but a consistent incidence could be due to the use of biologics that did not increase but compromised the ability of IBD patients to fight opportunistic fungal infections.

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Section: Discussionmentioning

confidence: 99%

Trends and outcomes of fungal infections in hospitalized patients of inflammatory bowel disease: a nationwide analysis

Mushtaq¹,

Khan²,

Aziz³

et al. 2020

Transl Gastroenterol Hepatol

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“…There were few data on the safety of azathioprine in HIV but a recent review of its use in 7 patients suggested that it had been used safely, without opportunistic infections, over a median of 12 months although two died but the authors stated ‘either death was associated with azathioprine therapy’ [97]. Of note, the only rheumatic syndrome treated with azathioprine in this series was myositis in one patient.…”

Section: Treatment Of Inflammatory Rheumatic Disease In the Context Omentioning

confidence: 92%

Evolving spectrum of HIV-associated rheumatic syndromes

Fox

Walker‐Bone

2015

Best Practice & Research Clinical Rheumatology

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At the end of 2013, 35 million people worldwide were infected with HIV. The prognosis of HIV has been transformed by combination antiretroviral therapy (cART). Providing compliance is good, the use of cART has normalised the life expectancy of HIV-infected people leading to a growing population of people with chronic infection. Management of HIV patients has therefore needed to adapt in order to not only control viral activity but also manage long-term complications of HIV and cART. Rheumatological manifestations of HIV were first described in 1989. Since then, there have been case reports, case series and epidemiological studies describing different clinical manifestations of HIV in the musculoskeletal system. This review will encompass musculoskeletal pain, fibromyalgia, systemic lupus erythematosus (SLE) and inflammatory arthritis in HIV. We will aim to report on the prevalence of these conditions and the risk factors, explore the impact of the virus on the clinical presentations and discuss implications for diagnosis and management.

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“…Although 2 patents died, this was not attributable to azathioprine. [73] TNF- activates viral replication and pathogenesis of HIV-1. [74] In a systematic review on the efficacy and safety of six biologics [rituximab, etanercept, adalimumab, alefacept, infliximab, ustekinumab] for several inflammatory conditions [including 3 IBD patients] in HIV-infected individuals, [75] there were 37 treatment episodes described and 33 episodes [89%] where anti-TNF agents were used.…”

Section: Hiv Infectionmentioning

confidence: 99%