Rheumatoid arthritis in patients with HIV: management challenges

Abstract

Over the past few decades, HIV has been transformed from a once-uniformly fatal disease to now a manageable but complex multisystem illness. Before highly active antiretroviral therapy (HAART), reports suggested that HIV-infected patients with rheumatoid arthritis (RA) would experience remission of their disease. It has now become clear that RA can develop in HIV-infected patients at any time, independent of HAART. Choosing the right medication to treat symptoms related to RA while avoiding excess weakening of the immune system remains a clinical challenge. Agents such as hydroxychloroquine and sulfasalazine might best balance safety with efficacy, making them reasonable first choices for therapy in HIV-infected patients with RA. More immune suppressing agents such as methotrexate may balance safety with efficacy, but data are limited. Corticosteroids such as prednisone may also be reasonable but could increase the risk of osteonecrosis. Among biologic response modifiers, tumor necrosis factor α inhibitors may balance safety with efficacy, but perhaps when HIV replication is controlled with HAART. Monitoring RA disease activity remains challenging as only one retrospective study has been published in this area. Those with HIV infection and RA can experience comorbidities such as accelerated heart disease and osteoporosis, a consequence of the chronic inflammatory state that each illness generates. Although HIV-infected patients are at risk for developing the immune reconstitution inflammatory syndrome when starting HAART, it appears that immune reconstitution inflammatory syndrome has a minimal effect on triggering the onset or the worsening of RA.

Current Drugs with Potential for Treatment of COVID-19: A Literature Review

“…The motivation for the use of antiviral drugs to treat COVID-19 infection, a viral disease, is obvious. However, the interest in the use of antimalarial drugs stems in the unexpected finding of beneficial effect of hydroxychloroquine in the treatment of HIV patients (29). Nevertheless, the beneficial effects of chloroquines in patients with COVID-19 needs to be tested through appropriately conducted clinical trials.…”

Methotrexate an Old Drug with New Tricks

“…There are limited data on the use of MTX therapy for the treatment of rheumatic disease in HIV- positive patients [235].…”

Joint damage in hiv positive patients

“…Риски развития серьезных инфекций также значимо не различались в зависимости от исходной вирус-ной нагрузки [58]. По мнению M. Carroll и соавт., примене-ние иФНО-α у больных РА с ВИЧ может рассматриваться как эффективное и безопасное до тех пор, пока инфекция находится под контролем с помощью ВААРТ [59].…”