The clinical management of HIV-associated arthritides remains difficult, likely reflecting the role of HIV-1 gene products in initiating or amplifying inflammatory joint disease. Most HIV-positive patients with mild rheumatic symptoms do well with conventional anti-inflammatory therapy, but some require the use of immunosuppressive-cytotoxic therapy. Indomethacin can directly inhibit HIV-1 replication and may be useful in combination with conventional antiviral agents . Sulfasalazine has shown efficacy in patients with HIV-associated seronegative arthritis . Hydroxychloroquine inhibits the posttranslational modification of glycoprotein 120 in T cells and monocytes, presumably by increasing endosomal pH and altering enzymes required for glycoprotein 120 production. Hydroxychloroquine suppressed HIV-1 replication in a dose-dependent manner. An additive effect of hydroxychloroquine with zidovudine was observed in the newly infected T and monocytic cells but not in the chronically infected cells . Thalidomide was reintroduced for the treatment of a few skin diseases and recent reports of original pharmacologic properties including inhibition of angiogenesis, modulation of cytokine production (mainly reduced tumor necrosis factor production), and effects on leukocyte functions through expression of cell adhesion molecules indicate that thalidomide may be useful in autoimmune disorders, such as RA, and a treatment for complications of HIV-1 infection [151-153]. Aurothioglucose contains monovalent gold ion and inhibits the DNA-binding of nuclear factor kappa B in vitro. These observations indicate that aurothioglucose is a potentially useful drug for the treatment of HIV-positive patients and arthritic complaints . Steroid and cytostatic treatment of rheumatic diseases may worsen the HIV disease . Etanercept has been successfully used for the treatment of HIV-asso-ciated PsA, but the clinical course was complicated by frequent polymicro-bial infections. The experience with this patient dictates that caution and careful follow-up must be exercised when prescribing anti-tumor necrosis factor therapy in the setting of HIV infection .
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