{"id":50,"date":"2008-09-10T17:38:46","date_gmt":"2008-09-10T22:38:46","guid":{"rendered":"http:\/\/blogs.nejm.org\/pov\/hiv-id-observations\/?p=50"},"modified":"2008-09-10T17:38:46","modified_gmt":"2008-09-10T22:38:46","slug":"yes-tnf-blockers-increase-infection-risk-now-what","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/yes-tnf-blockers-increase-infection-risk-now-what\/2008\/09\/10\/","title":{"rendered":"Yes, TNF blockers increase infection risk. Now what?"},"content":{"rendered":"<p>So the FDA has issued (another) <a href=\"http:\/\/www.fda.gov\/bbs\/topics\/NEWS\/2008\/NEW01879.html\" target=\"_blank\">warning about TNF (tumor necrosis factor) blockers and increased infection risk<\/a>, this time focusing on fungal infections, in particular histoplasmosis.\u00a0 TNF blockers are used for treatment of rheumatoid arthritis, Crohn&#8217;s Disease, ankylosing spondylitis, psoriasis, and a wide range of other autoimmune diseases, both in approved and\u00a0in off-label use.<\/p>\n<p>ID\/HIV specialists of a certain age can easily remember the first patients they had who, after starting PI-based combination therapy (<a href=\"http:\/\/blogs.nejm.org\/pov\/hiv-id-observations\/index.php\/2008\/04\/10\/needed-something-better-than-haart\/\">note I don&#8217;t say &#8220;HAART&#8221;<\/a>), literally got their life back.\u00a0 Went from imminent death to joining the living again.\u00a0 It was miraculous.\u00a0\u00a0A similar\u00a0thing happened when TNF blockers entered clinical trials, then were approved by the FDA.<\/p>\n<p>No, the TNF blockers don&#8217;t usually reverse a fatal illness like the antiretrovirals.\u00a0 But\u00a0their effect, while perhaps not literally life-saving, is <em>nearly<\/em> as profound.\u00a0It doesn&#8217;t much matter what the disease is; for patients with severe RA, or Crohn&#8217;s, or whatever, going from a life of chronic pain and disability to feeling normal again\u00a0is, well, a miracle of almost comparable magnitude to the reversal of AIDS with antiretroviral therapy.<\/p>\n<p>That&#8217;s why seeing patients with serious infectious complications from these drugs is so challenging.\u00a0 It&#8217;s not just about treating the infection.\u00a0 It&#8217;s also about managing the post-infection life.\u00a0<\/p>\n<p>And coming up with a sensible, compassionate answer to the inevitable question, &#8220;When can I start the Enbrel [or Remicade, or Humira, or Cimzia &#8230;] again?&#8221; &#8212; is certainly one of the hardest things I do.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>So the FDA has issued (another) warning about TNF (tumor necrosis factor) blockers and increased infection risk, this time focusing on fungal infections, in particular histoplasmosis.\u00a0 TNF blockers are used for treatment of rheumatoid arthritis, Crohn&#8217;s Disease, ankylosing spondylitis, psoriasis, and a wide range of other autoimmune diseases, both in approved and\u00a0in off-label use. ID\/HIV [&hellip;]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3,5,8],"tags":[243,421,808,930],"class_list":["post-50","post","type-post","status-publish","format-standard","hentry","category-health-care","category-infectious-diseases","category-patient-care","tag-crohns-disease","tag-histoplasmosis","tag-rheumatoid-arthritis","tag-tnf-blockers"],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/50","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/comments?post=50"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/50\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/media?parent=50"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/categories?post=50"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/tags?post=50"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}