Background/Purpose: Patients with Human Immunodeficiency Virus (HIV) infection may benefit from the use of anti-Tumor Necrosis Factor (TNF) therapy in the setting of inflammatory disease, but the safety of this therapy in patients with HIV infection has not been well established.

Methods: All patients seen at an academic medical center with HIV infection who were prescribed anti-TNF therapy from 1/1/2014-5/1/2019 were identified through retrospective chart review. 11 patients met these criteria. Clinical characteristics, CD4 counts, HIV viral loads, and adverse outcomes including Emergency Department visits, hospitalizations, major infections, malignancies, and death are reported. IRB approval was obtained.

Results: The mean age of patients in this cohort was 48.4, and 90.9% of these patients were male. Indications for anti-TNF use included inflammatory bowel disease (45.4%), psoriatic arthritis (27.2%), rheumatoid arthritis (27.2%), psoriasis (9.1%), and hidradenitis suppurativa (9.1%). The mean duration of anti-TNF use was 52.3 months (range 7-168 months, standard deviation 54.9 months). There were 13 uses of anti-TNF therapy among 11 patients. There were 4 uses of infliximab, 4 uses of etanercept, 4 uses of adalimumab, and 1 use of certolizumab.

All patients were on antiretroviral therapy (ART) at the time of initial anti-TNF prescription, and remain on ART. 72.7% of patients received at least one DMARD in conjunction with anti-TNF use.

There was no significant change in CD4 count during anti-TNF therapy (mean change 103, p = 0.34). At the initiation of anti-TNF therapy, 72.7% of patients had undetectable HIV viral loads and 27.3% of patients had detectable viral loads. At the most recent check, all patients had undetectable viral loads. There were no instances of development of a detectable viral load once it became undetectable.

No major infections occurred over 47.9 person-years on anti-TNF therapy. There were 20 ED visits and 10 hospitalizations over this time course, but none were for infections, heart failure, or other complications of anti-TNF therapy.

Two malignancies were diagnosed over 47.9 person-years: an abdominal leiomyosarcoma diagnosed after 12 months of infliximab therapy for Crohn’s disease, and a metastatic cholangiocarcinoma diagnosed after 168 months on etanercept for rheumatoid arthritis.

Conclusion: In 11 HIV-infected patients receiving anti-TNF therapy along with ART, anti-TNF therapy did not impact CD4 counts or viral load. No major infections were seen in this population. Two malignancies developed but they not clearly related to HIV infection, anti-TNF therapy, or the underlying disease requiring anti-TNF therapy. We suggest that with appropriate monitoring and consistent use of ART, patients with HIV infection may safely receive anti-TNF medications.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/anti-tnf-therapy-in-patients-with-hiv-infection/