Background/Purpose:

Few HIV-infected patients have been treated with tumor necrosis factor (TNF)-α inhibitor therapy for autoimmune diseases refractory to conventional therapies. Evidence supporting the safety of TNF-α inhibitor therapy in HIV-infected individuals is limited and based on isolated case reports and small series.

Objective:

To estimate the incidence of serious infections in patients with HIV infection who are treated with TNF-α inhibitors therapy for concomitant autoimmune diseases, and to compare these rates between certain CD4+ cell count and viral load levels.

Methods:

Using a unified search strategy of the electronic medical record EPIC, four centers identified HIV infected patients exposed to TNF-α inhibitors. Patient characteristics and infection data were assessed via chart review in all HIV-infected patients who are ≥ 18 years old and have received TNF-α inhibitor therapy after HIV diagnosis between January 1999 and March 2015.

Results:

The inclusion criteria were met in 23 patients with 26 uses of TNF-a inhibitor therapy, 16 treated with Etanercept, 6 with Adalimumab and 4 with Infliximab. The median (range) age was 47 (20-66). The median (range) CD4+ cell count and viral load at therapy initiation was 541.5 (1-1100) and undetectable (undetectable to 298,281), respectively at time of biologic therapy initiation. These individuals provided 86.7 person-years of followup. Two (8.7%) experienced at least 1 serious infection episode (SIE) (pneumonia with empyema and MSSA chest tube infection), an overall incidence rate for all treatment courses of 2.3 per 100 patient-years (95% CI [Confidence Interval] 0.26-8.33). Both of them were on Etanercept before infectious episodes; at the time of the infection in both, viral load was < 50 and CD4+ cell count was increased from the time of TNF inhibitor initiation (209 and 804 cells/mm3 at time of SIE). There were no opportunistic infections. The incidence rate per 100 patient-years was 3.28 (95% CI 0.04-18.26) among patients with viral load > 500 copies/mL at therapy initiation and 2.08 (95% CI 0.03-11.6) among patients with viral load ≤ 500 copies/mL. One of them was on TNF inhibitor monotherapy while the other was on low-dose corticosteroid.

Conclusion:

This study suggests that TNF-α inhibitor therapy may have reasonable rates of SIEs in the range of those observed in registry data bases when used in patients with HIV infection under active care.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/infection-rate-in-hiv-patients-who-received-tnf-a-inhibitor-therapy-for-concomitant-autoimmune-diseases/