Long-Term Safety and Efficacy of Anti-TNF Agents in Patients with HIV Infection

A longitudinal case series of patients who are human immunodeficiency virus (HIV)-positive reported favorable safety outcomes of long-term use of anti-tumor necrosis factor (TNI) agents. These data were presented at the American College of Rheumatology (ACR) Convergence 2021.

In a previous case series, the research team reported five-year outcomes of anti-TNF use in eight HIV-positive patients. For this study, the team extended their analysis to include a total of 18 patients with HIV treated anti-TNF agents between 2003 and 2021. Most patients were treated at the Harris County HIV Outpatient Clinic in Texas. Patient data collected at baseline included sociodemographic characteristics, CD4 counts, HIV viral load, and medications used.

For patients with rheumatoid arthritis (RA) or spondyloarthritis (SpA), initial treatment was non-steroidal anti-inflammatory drugs (NSAIDs), non-biologic disease modifying antirheumatic drugs (DMARDS), primarily methotrexate or sulfasalazine, and intra-articular/intralesional corticosteroids. If patients demonstrated persistent disease activity despite conservative therapy and had CD4 counts above 200 cells/μl, and a HIV viral load of less than 60,000 copies/ml (as per guidelines for use of immunosuppressive agents in patients with HIV infection), then these patients were started on anti-TNF agents.

Out of 18 patients at baseline, eight were previously treated with anti-TNF agents between 2003 and 2006 as part of the initial case series (RA, n = 2; peripheral SpA, n = 2), including seven with long-term follow-up data. The remaining nine patients were treated with anti-TNF agents since 2006.

Overall, no major infectious episodes occurred that required treatment discontinuation. Thirteen patients are still currently being followed, including four from the initial case series (adalimumab, n = 1; ustekinumab, n = 1; remission, n = 2). Six of the nine patients added to the series after 2006 are still currently receiving anti-TNF agents. Of three patients who discontinued treatment, one discontinuation was due to lack of efficacy, one was due to rising HIV load, and one patient discontinued due to fear of toxicity, though the authors note that no toxicity event was recorded.

In conclusion, the authors wrote, “our data underscore the safety of using anti-TNF agents in patients with HIV infection over long duration, provided standard precautions of using immunosuppressive agents in the setting of HIV infection are followed.”