Infectious Disease Special Edition: Immunomodulators in patients living with HIV

Infectious Disease Special Edition clinical review

Immunomodulators can offer both stimulatory and suppressive effects to regulate or control the immune system through modulation of immune mediators like lymphocytes, macrophages, neutrophils, natural killer (NK) cells, and cytokines. Medications classified as “immunomodulators” can include glucocorticoids, cytostatic drugs commonly used in chemotherapy and transplant immunosuppression, and monoclonal antibodies or biologics. These agents have a vast list of clinical indications including but not limited to the management of rheumatic, pulmonary, dermatologic, gastrointestinal, and oncologic diseases.

One of the most common warnings listed in the prescribing information of immunosuppressive medications is the risk of acquiring severe or opportunistic infections. Infections may be bacterial, fungal, or viral in nature, which leads to recommendations for certain laboratory testing to be completed before medication initiation. The degree of immunosuppression can vary depending on the agent used and is dependent on the mechanism of action and specific pathways affected.

Immunomodulators are increasingly becoming a core component in the management of many disease states, including HIV-related metabolic complications. Due to the increased utilization and risks associated with these agents, along with the increasing number of older adults living with HIV who may have conditions for which these agents are recommended, providers need to consider the safety and efficacy of these agents, especially in people living with HIV.

Read the full review here.

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