期刊
AIDS
卷 34, 期 8, 页码 1171-1179出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/QAD.0000000000002549
关键词
biologic; checkpoint inhibitor; HIV; tumor necrosis factor inhibitor
资金
- National Institutes of Allergy and Infectious Diseases, National Institutes of Health [T32 AI60530-12]
- UCSF Academic Research Systems
- National Center for Advancing Translational Sciences, National Institutes of Health, through UCSF-CTSI [UL1 TR991872, UL1 RR024131]
- National Institute on Minority Health and Health Disparities, National Institutes of Health [U54 GM118986]
- National Institute of Allergy and Infectious Diseases, National Institutes of Health [R01 AI141003, UM1 AI126622, R01 AI122862]
- UCSF Resource Allocation Program
- Division of Experimental Medicine
Objectives: Immunomodulatory drugs (IMDs) are crucial for treating autoimmune, inflammatory, and oncologic conditions. Data regarding the safety of IMDs in people living with HIV (PLWH) are limited. We describe outcomes in all PLWH prescribed these agents from 2000--2019 at two academic medical centers. Design: Retrospective cohort study. Methods: We systematically identified and reviewed charts of all PLWH receiving IMDs. We defined a treatment episode as an uninterrupted period on an IMD regimen. We quantified infections, blips (detectable plasma HIV RNA following an undetectable result), and virologic failure (progression from plasma HIV RNA 200 copies/ml despite ART). Results: Seventy-seven patients contributed 110 treatment episodes. Rheumatologic comorbidities were the most frequent indication. The most common IMD classes were TNF inhibitors, antimetabolites, and checkpoint inhibitors. Ninety percent of treatment episodes involved concomitant ART. Median pretreatment CD4(+)T-cell count was 609 cells/mu l (IQR 375--861). Among 51 treatment episodes on ART with undetectable pretreatment plasma HIV RNA, HIV became detectable within 1 year in 21 of 51 cases (41.2%); there were no instances of virologic failure. Compared with other agents, treatment episodes involving checkpoint inhibitors were more likely to involve a blip (77.8 vs. 33.3%,P = 0.015). Thirteen treatment episodes (11.8%) were associated with concomitant infection; none was attributed to IMDs by the treating clinician. Conclusion: PLWH treated with IMDs should be monitored carefully for virologic blips and incident infections. Checkpoint inhibitors may be associated with a higher rate of viral blips, although the clinical significance is unclear.
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