title: Use of infliximab to treat psoriatic arthritis in HIV-positive patients.
abstract: Psoriatic arthritis in HIV-positive patients is not only severe, but also raises specific treatment challenges, as immunosuppressant and immunomodulating agents may adversely affect both the course of the HIV infection and the risk of opportunistic infections. TNFalpha antagonists have not been evaluated in patients with HIV infection, which is therefore considered to contraindicate their use. Two HIV-positive patients with psoriatic arthritis unresponsive to methotrexate alone were treated with infliximab (5 and 2 mg/kg, respectively), methotrexate, and antiretroviral drugs. Dramatic improvements in the skin and joint manifestations occurred in both patients. Tolerance was good, after follow-ups of 24 and 50 months, respectively. No opportunistic infections occurred. Viral load remained well controlled and CD4+T-cell counts stable, although both patients required adjustments in their antiretroviral regimens based on close monitoring of these two parameters. HIV infection classically contraindicates the use of TNFalpha antagonists to treat refractory inflammatory joint disease. However, exceptions to this rule can be made in carefully selected patients who have exhausted all other treatment options for their joint disease and who respond well to antiretroviral therapy. Potential long-term effects such as opportunistic infections, malignancies, and loss of HIV control need to be evaluated.
authors.affiliation: Rheumatology Department, Saint-Antoine Teaching Hospital, AP-HP, Paris, France. jeremsellam@yahoo.fr <jeremsellam@yahoo.fr>
authors.forename: Jérémie
authors.initials: J
authors.lastname: Sellam
authors.forename: Béatrice
authors.initials: B
authors.lastname: Bouvard
authors.forename: Charles
authors.initials: C
authors.lastname: Masson
authors.forename: Mickael
authors.initials: M
authors.lastname: Rousière
authors.forename: Caroline
authors.initials: C
authors.lastname: Villoutreix
authors.forename: Karine
authors.initials: K
authors.lastname: Lacombe
authors.forename: Vanessa
authors.initials: V
authors.lastname: Khanine
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Chennebault
authors.forename: Christian
authors.initials: C
authors.lastname: Leclech
authors.forename: Maurice
authors.initials: M
authors.lastname: Audran
authors.forename: Francis
authors.initials: F
authors.lastname: Berenbaum
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D015535:Arthritis, Psoriatic / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology*; D004359:Drug Therapy, Combination; D015658:HIV Infections / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D000069285:Infliximab; D008297:Male; D016896:Treatment Outcome
chemical_list: D019380:Anti-HIV Agents; D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D000069285:Infliximab