title: Successful use of antitumor necrosis factor-alpha biological therapy in managing human immunodeficiency virus-associated arthritis: three case studies from Saudi Arabia.
abstract: Arthralgic disorders involving various rheumatic manifestations are commonly observed in HIV patients. Available therapies for HIV-associated rheumatic syndromes include non-steroidal anti-inflammatory drugs for pain management, disease-modifying antirheumatic drugs (e.g., methotrexate), and antitumor necrosis factor-alpha therapies. However, treatment of HIV-associated arthritis can be challenging, particularly in patients with co-infections like hepatitis viruses, and therapeutic strategies are not well defined. Here, we present three case reports on the use of antitumor necrosis factor-alpha agents for HIV-associated arthritis. We managed three cases of HIV-associated arthritis following initial presentation. All patients were on highly active antiretroviral therapy with stable HIV loads and CD4(+) cell counts. Data were reported for treatment of inflammatory arthritis using 5 months of etanercept followed by adalimumab for case 1, and 12 months of etanercept for case 2. In case 3, reactive arthritis was treated with 5 months of etanercept followed by adalimumab. In all three cases, significant improvement or resolution of arthritis was achieved following treatment with antitumor necrosis factor-alpha therapies. Moreover, these case studies demonstrated the safe and effective use of antitumor necrosis factor-alpha agents in HIV patients with hepatitis B and/or C virus co-infection. Our results indicate that antitumor necrosis factor-alpha therapies can be successfully used for HIV-infected patients with stable HIV loads and CD4(+) lymphocyte counts.
authors: Department of Medicine, Medical College, Umm Alqura University, PO Box 1821, 21441 Jeddah, Saudi Arabia. hanialmoallim@hotmail.com
authors: Hani
authors: H
authors: Almoallim
authors: Ibtisam
authors: I
authors: Jali
authors: Ghassan
authors: G
authors: Wali
mesh_terms: D000068879:Adalimumab; D000328:Adult; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001170:Arthritis, Infectious / Q000188:drug therapy* / Q000453:epidemiology*; D015897:Comorbidity; D000068800:Etanercept; D005260:Female; D006678:HIV; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology*; D016174:Hepacivirus; D006509:Hepatitis B / Q000453:epidemiology; D006515:Hepatitis B virus; D006526:Hepatitis C / Q000453:epidemiology; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use*; D012529:Saudi Arabia; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D000068879:Adalimumab; D000068800:Etanercept
keywords: Anti-TNF-alpha; Biologic therapy; HIV infection; HIV-associated arthritis; Methotrexate; Polyarthritis