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Rheumatic and autoimmune disease is a well known association of HIV disease. Entities include vasculitis, arthropathy, arthritis, myopathy, psori-atic disease, and diseases resembling sarcoidosis and Sjogren's disease. This is likely caused by both manifestation of primary disease and resultant dysregulation and hyperactivity of immune response and a consequence of subsequent effective immune reconstitution with highly active antiretroviral therapy [165,166].

Rheumatic disease in HIV prompts consideration of treatment with immunosuppressive therapy in patients who are at risk for life-threatening deterioration of immune defense. TNF-a is required for host response to intracellular pathogens, suggesting use of anti-TNF agents in HIV disease is a worrisome prospect. Anti-TNF therapy has been used successfully in HIV-positive patients with progressive psoriatic arthritis [167,168] and Reiter syndrome [169]. Etanercept given as pretreatment against immune activation of IL-2 revealed no effect on HIV viral load [170]. As in other chronic viruses, circulating TNF levels are found to be elevated in HIV disease proportionately to degree of compromise and presence of opportunistic infections. TNF-a may facilitate lymphocyte depletion and dysfunction and viral replication [166,171]. Etanercept given adjuvantly to TB therapy in HIV-positive patients not on highly active antiretroviral therapy was without adverse events and increased CD4+ T-cells by 25%; however, there was no reduction of viral load [40]. Oral anti-TNF-alpha agents with a half-life of mere hours requiring twice daily dosing may be imminently available and confer a safer treatment profile for HIV rheumatic disease. Further studies regarding the use of anti-TNF therapy in HIV rheumatic disease are warranted.

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Arthritis Relief and Prevention

Arthritis Relief and Prevention

This report may be oh so welcome especially if theres no doctor in the house Take Charge of Your Arthritis Now in less than 5-Minutes the time it takes to make an appointment with your healthcare provider Could you use some help understanding arthritis Maybe a little gentle, bedside manner in your battle for joint pain relief would be great Well, even if you are not sure if arthritis is the issue with you or your friend or loved one.

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