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  • 1.  HIV and methotrexate

    Posted 04-17-2025 07:02

    Hello all,

    We have a woman with asymptomatic HIV and biopsy proven sarcoidosis,  treated her previously with prednisone, however CT scan recently has shown worsening hilar adenopathy, sarcoid involvement in the lungs. Pulmonology is planning to treat again with prednisone, and noted she may need additional treatment with methotrexate, long term. 

    She has good adherence with Biktarvy, CD4 has been between 300-600 for the last several years, last CD4 was 431. HIV viral load not detected. Not alot of other comorbidities, GERD, HTN. 

    Would you recommend starting an antibiotic now for OI prophylaxis, due to the increased risk with immunosuppression? If so, which one? It appears Bactrim would increase MTX toxicity. Thank you for your comments. 



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    Barbara Hart
    Lawrence KS
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  • 2.  RE: HIV and methotrexate

    Posted 04-17-2025 15:46

    Barbara,

    The HIV isn't really a consideration here, since it's well controlled. Decisions about prophylaxis while on immunosuppressive agents are essentially the same as they would be in someone without HIV.  



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    Joel Gallant, MD, MPH
    Johns Hopkins University
    Baltimore, MD

    AXCES Research Group
    Santa Fe, NM
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    Original Message


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