How do you think about biologic use in patients with underlying HIV infection?

This is always a difficult problem, and a tough clinical call. However, over the years of seeing these people, I have come to realize that following their viral load and CD4 counts while looking for immunologic recovery allows us as Rheumatologists a lot of opportunities to treat. While I have classically started with non-biologic medications (sulfasalazine and hydroxychloroquine), if the patient has well-controlled HIV disease, I have successfully progressed to biologic therapy, most commonly anti-TNF therapy. By following along with infectious disease, and ensuring that the anti-retroviral and combination therapies are keeping the patient’s HIV Disease under good control, I have been able to successfully walk the tight rope of immunosuppr...

I agree with Dr. @Dr. First Last. I communicate with the patient ID physician. If they have well controlled HIV, then you can essentially treat them like other patients. Those with poor adherence or who choose not to take anti-retroviral therapy are another story.