Case report: Safety and efficacy of adalimumab in treating difficult-to-treat rheumatoid arthritis in a human immunodeficiency virus-positive patient, one year follow-up

Abstract

Rheumatoid arthritis (RA) is a joint-disabling inflammatory disease associated with the pathology of synovitis. Some patients with RA are difficult to treat, using disease-modifying anti-rheumatic drugs (DMARDs). Biology and targeted synthetic DMARDs (b/tsDMARDs) are options for patients with RA. Acquired immunodeficiency syndrome (AIDS) is an infectious disease caused by the human immunodeficiency virus (HIV). Adalimumab is an anti-tumor necrosis factor therapy commonly used in patients with RA. However, there are no reports or related data on patients with RA-HIV/AIDS treated with adalimumab are available. In this report, we described the first successful case of a 60-year-old HIV-positive woman with difficult-to-treat RA treated with ADA after being screened for hepatitis virus, latent tuberculosis (LTBI), and other infections. She contracted HIV from sexual exposure while on adalimumab therapy. As the patient was resistant to first-line DMARDs, she continued adalimumab along with the initiation of highly active antiretroviral therapy (HAART). The patient was treated with adalimumab therapy for a year; her CD4+ lymphocyte count was normal, HIV-1 RNA decreased, and no new infections were triggered. The patient achieved clinical remission of RA. In conclusion, adalimumab is a safe option for patients with RA-HIV and may slow the progression of HIV infection. Furthermore, HAART has the potential to reduce joint pain and fatigue in patients with difficult-to-treat RA.ConclusionsAdalimumab is a safe option for patients with RA-HIV, and may slow down the progression of HIV infection. The HAART therapy has the potential to reduce joint pain and fatigue in patients with difficult-to-treat RA.

Endogenous retroelement activation is implicated in IFN-α production and anti-CCP autoantibody generation in early RA

“…In conclusion, we examine for the first-time endogenous retroelement (ERE) activity in early RA and present potentially important associations between ERE activity, IFN-I, B-cell function and autoantibody generation. Within this context it is intriguing to note that antiretroviral drugs (HAART) have ameliorated symptoms in RA (57) and further work is needed to comprehensively explore the putative pathogenic involvement of EREs in RA. This will allow greater understanding of RA pathophysiology and potentially provide new targets for disease treatment or even disease prevention.…”

The use of a tumor necrosis factor inhibitor—adalimumab—in the management of arthritis in an adolescent with HIV: A case report

“…Two other reports described patients on TNFi who contracted HIV infection during the course of their treatment; nevertheless, bDMARDs were continued along with the initiation of HAART. 17,18 Our 11-year-old male patient presented with inflammatory arthritis, enthesitis, sacroiliac joint tenderness, positive HLA-B27 antigen, negative RF, and a history of Crohn's disease in his mother.…”

“…Discontinuation of bDMARDs was possible with no recurrence of his symptoms. Two other reports described patients on TNFi who contracted HIV infection during the course of their treatment; nevertheless, bDMARDs were continued along with the initiation of HAART 17,18 …”