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Systematic review of the efficacy and safety of biological therapy for inflammatory conditions in HIV-infected individuals

Fink, DL; Hedley, L; Miller, RF; (2017) Systematic review of the efficacy and safety of biological therapy for inflammatory conditions in HIV-infected individuals. International Journal of STD & AIDS , 28 (2) pp. 110-119. 10.1177/0956462416675109. Green open access

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Abstract

Biologic therapies are injectable immunomodulatory agents directed against specific immune cell or chemical targets. They have transformed the lives of HIV-uninfected individuals with severe inflammatory conditions including psoriasis, rheumatoid arthritis, and ulcerative colitis. The perceived increased infection risk associated with these agents means that HIV-infected individuals have not been included in randomised control trials of these drugs. The literature for use of biologic therapies in HIV-infected populations is limited to case reports and case series. There are additional data on use of rituximab, a monoclonal antibody against B lymphocytes, in the setting of HIV-associated haematological malignancy. We performed a systematic review of efficacy and safety of biologic therapy for inflammatory conditions in HIV-infected individuals. Our systematic review identified 37 treatment episodes with six different biologic agents encompassing 10 different inflammatory conditions. Broadly, efficacy of the agents studied was comparable to reports from HIV-uninfected patients. Both infectious and non-infectious sequelae were also comparable with trial data from HIV-uninfected patients. HIV control, even for the minority of individuals not receiving anti-retroviral therapy (ART) at the time of biologic therapy, was not adversely affected. However, detail was limited concerning ART regimens and both immunological and virological parameters of follow-up. Overall available literature is of very low quality and likely subject to publication bias of successful cases. Firm conclusions are not possible regarding the efficacy and safety of biologic agents in HIV-infected individuals; however, there appear to be sufficient data to warrant inclusion of individuals with well-controlled HIV in future trial studies.

Type: Article
Title: Systematic review of the efficacy and safety of biological therapy for inflammatory conditions in HIV-infected individuals
Open access status: An open access version is available from UCL Discovery
DOI: 10.1177/0956462416675109
Publisher version: http://dx.doi.org/10.1177/0956462416675109
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Infectious Diseases, HIV, biologic therapy, dermatology, gastroenterology, rheumatology, HUMAN-IMMUNODEFICIENCY-VIRUS, OF-THE-LITERATURE, ACTIVE ANTIRETROVIRAL THERAPY, RHEUMATOID-ARTHRITIS, BOWEL-DISEASE, PSORIATIC-ARTHRITIS, CHANGING SPECTRUM, POSITIVE PATIENT, RISK, ETANERCEPT
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Infection and Immunity
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health > Infection and Population Health
URI: https://discovery.ucl.ac.uk/id/eprint/10044743
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