Abstract
After approval, initial biologics etanercept, infliximab, and adalimumab became useful in the therapeutic armamentarium to treat rheumatoid arthritis (RA) patients who had an inadequate response to disease-modifying anti-rheumatic drugs (DMARDs). However, all phase-III clinical trials submitted to the FDA, by design, excluded patients who were human immunodeficiency virus (HIV) positive. They are another subset of patients with low immunity due to their HIV-positive status. Very little information is available about the use of biologics in this new group of patients if they fail to respond to DMARDS. The available literature is limited to case reports about HIV-positive RA patients with reported side effects. These side effects range from no opportunistic infections (OIs) in some to acute respiratory distress syndrome (ARDS) and disseminated intravascular coagulopathy (DIC) reported in others. Some HIV cases may initially present with rheumatological manifestations. With growing epidemiologic evidence of frequent joint manifestations in HIV-positive patients, HIV testing should be done more frequently in patients with RA, even those who deny risk factors for HIV. This review may help develop future guidelines on how to manage HIV-positive RA patients.
Highlights
BackgroundCenter for Disease Control and Prevention (CDC) reported around 54.4 million adults who were diagnosed with rheumatological diseases between 2013 and 2015 in the US [1]
Rheumatological diseases include various diagnoses such as rheumatoid arthritis (RA), fibromyalgia, seronegative spondyloarthropathies such as psoriatic arthritis (PsA), ankylosing spondylitis, and reactive arthritis. They adversely affect the functional capabilities of the patients and are a substantial socioeconomic burden. Management of these patients seems challenging with co-morbidities and chronic infections with hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV)
Diagnosis heavily relies on histopathological examination confirming lymphocytic infiltration in the absence of anti-Ro/SSA and anti-La/SSB and more cluster of differentiation 8+ T cells (CD8+ T) infiltration than CD4+, with symptoms improving after the introduction of highly active antiretroviral treatment (HAART) into the treatment plan [11]
Summary
Glomerulonephritis: Very few cases of glomerulonephritis were reported with TNF-α inhibitors; discontinuation of these agents with steroids and immunosuppressive medications leads to improvement [18] Is it HIV presenting with arthritis or is it a rheumatological disease with comorbid HIV infection?. Diagnosis heavily relies on histopathological examination confirming lymphocytic infiltration in the absence of anti-Ro/SSA and anti-La/SSB and more cluster of differentiation 8+ T cells (CD8+ T) infiltration than CD4+, with symptoms improving after the introduction of HAART into the treatment plan [11] In another case-control study by Berman et al [26], reported myalgia in HIV-infected cases is twice as common as in the HIV-negative control group.
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