How would you approach immunosuppression in a patient with well-controlled HIV and RF+ rheumatoid arthritis breaking through hydroxychloroquine with ongoing inflammation confirmed on ultrasound?

The Infectious Disease Society of America (IDSA) defines HIV viral suppression as a viral load that is persistently below the level of quantification or detection of the assay used to measure the viral load. Prevention of sexual transmission is thought to occur at levels less than 200 copies of viru...

There is a reasonable amount of literature on this topic. The consensus is that if ongoing HAART therapy is effective at controlling viral load and maintained, Methotrexate and TNF antagonists are well tolerated; they do not seem to affect HIV viral load. The safety of JAK inhibitors, leflunomide, a...

All good & reasonable responses- agree the safety data on biologics in well-controlled HIV (virologically and immunologically) is limited and descriptive, but in our experience very well tolerated and effective. There is also a reported experience in immune reconstitution syndromes with these agents...

I will discuss with patient’s ID about his current condition, then get agreement on an appropriate treatment.