Rheumatoid arthritis in patients with HIV: management challenges

• Published in: Open Access Rheumatology Vol. 8; no. Issue 1; pp. 51 - 59
• Main Authors: Carroll, Matthew B, Fields, Joshua H, Clerc, Philip G
• Format: Journal Article Book Review
• Language: English
• Published: New Zealand Dove Medical Press Limited 01-01-2016; Taylor & Francis Ltd; Dove Medical Press
• Subjects: Acquired immune deficiency syndrome; AIDS; Antiretroviral drugs; Antirheumatic agents; Arthritis; Cardiovascular Disease; Care and treatment; Chronic illnesses; Development and progression; Disease susceptibility; Drug therapy; Highly active antiretroviral therapy; HIV; HIV (Viruses); HIV patients; Human Immunodeficiency Virus; Immune Reconstitution Inflammatory Syndrome; Infections; Inflammation; Osteoporosis; Patients; Peptides; Review; Rheumatoid Arthritis; Rheumatoid factor; Rheumatology; United States > US; human immunodeficiency virus; cardiovascular disease; immune reconstitution inflammatory syndrome; osteoporosis; rheumatoid arthritis
• ISSN: 1179-156X; 1179-156X
• DOI: 10.2147/OARRR.S87312

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.