Association of human immunodeficiency virus infection and autoimmune phenomena

doi:10.1016/0002-9343(88)90012-5

The American Journal of Medicine

Volume 84, Issue 1, January 1988, Pages 82-88

https://doi.org/10.1016/0002-9343(88)90012-5 Get rights and content

Abstract

Patients infected with human immunodeficiency virus have a variety of presentations including fevers, lymphadenopathy, rash, renal dysfunction, and neurologic and hematologic disorders. Many of these features are also seen in patients with systemic lupus erythematosus (SLE). Herein are described five patients ultimately diagnosed as having acquired immunodeficiency syndrome (AIDS) or AIDS-related complex (ARC) in whom the differential diagnosis included SLE because of multi-system disease and autoimmune phenomena, especially positive antinuclear antibodies. Serum samples from 151 consecutive patients with AIDS or ARC were examined and 19 with low titer-positive antinuclear antibodies were found (17 at 1:20 and two at 1:160). These observations suggest that SLE and human immunodeficiency virus infection may share clinical and serologic features.

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At the end of 2013, 35 million people worldwide were infected with HIV. The prognosis of HIV has been transformed by combination antiretroviral therapy (cART). Providing compliance is good, the use of cART has normalised the life expectancy of HIV-infected people leading to a growing population of people with chronic infection. Management of HIV patients has therefore needed to adapt in order to not only control viral activity but also manage long-term complications of HIV and cART. Rheumatological manifestations of HIV were first described in 1989. Since then, there have been case reports, case series and epidemiological studies describing different clinical manifestations of HIV in the musculoskeletal system. This review will encompass musculoskeletal pain, fibromyalgia, systemic lupus erythematosus (SLE) and inflammatory arthritis in HIV. We will aim to report on the prevalence of these conditions and the risk factors, explore the impact of the virus on the clinical presentations and discuss implications for diagnosis and management.
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In the majority of patients, the SLE responded to treatment with oral CS with or without hydroxychloroquine (HCQ). This group included 27 patients as shown in Table 3 [7,8,10,15,27,31,44–61]. The duration of SLE prior to the diagnosis of HIV infection ranged from 2 weeks to 204 mo (median duration 72 mo).
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We performed a retrospective review of the records of patients with SLE and HIV seen in the Department of Rheumatology at the Inkosi Albert Luthuli Central Hospital, Durban, South Africa. We used the terms “systemic lupus erythematosus” and “HIV” or “AIDS” to identify patients with SLE and HIV infection reported in the English medical literature.
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^☆: This work was supported in part by funding from the National Institutes of Health (AI-62542 and AI-72658), by a grant from the New York State AIDS Institute, and by research funds from the Veteran's Administration.

^☆☆: This work was presented in abstract form at the Northeastern Regional Meeting of the American Rheumatism Association, October 1986, and the American Rheumatism Association National Meeting, June 1987.

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Association of human immunodeficiency virus infection and autoimmune phenomena☆,☆☆

Abstract

Clin Immunol Immunopathol

Am J Med

J Am Acad Dermatol

J Am Acad Dermatol

Am J Med

Lancet

Blood

Am J Med

Lancet

Lancet

Lancet

An outbreak of community-acquired Pneumocystis carinii pneumonia

N Engl J Med

Update: acquired immunodeficiency syndrome (AIDS)—United States

MMWR

Revision of the case definition of acquired immunodeficiency syndrome for national reporting—United States

MMWR

Quantitation of B2-microglobulin and other immune characteristics in a prospective study of men at risk for acquired immune deficiency syndrome

JAMA

The epidemiology of AIDS and related conditions

The 1982 revised criteria for the classification of systemic lupus erythematosus

Arthritis Rheum

The neurological manifestations of systemic lupus erythematosus

Medicine (Baltimore)

Neurological complications of acquired immune deficiency syndrome: analysis of 50 patients

Ann Neurol

Progressive polyradiculopathy in acquired immunodeficiency syndrome

Neurology

Neurological manifestations of the acquired immunodeficiency syndrome (AIDS): experience at UCSF and review of the literature

J Neurosurg

Inflammatory neuropathy in homosexual men with lymphadenopathy

Neurology

Acute neuropathy coincident with seroconversion for anti LAVHTLV III

Lancet

Polymyositis associated with AIDS retrovirus

JAMA

Isolation of HTLV III from cerebrospinal fluid and neural tissues of patients with neurologic syndromes related to the acquired immunodeficiency syndrome

N Engl J Med

The use of plasmapheresis, lymphocytapheresis and staph protein-A immunoabsorption as an immunomodulatory therapy in patients with AIDS and AIDS-related conditions

J Clin Apheresis

Acquired immunodeficiency syndrome (AIDS)—apheresis and operative risks

J Clin Apheresis

Renal disease in patients with AIDS: a clinicopathologic study

Clin Nephrol

Glomerular lesions in the acquired immunodeficiency syndrome

Ann Intern Med

Associated focal and segmental glomerulosclerosis in the acquired immunodeficiency syndrome

N Engl J Med

Immunological studies concerning the nephritis of systemic lupus erythematosus

J Exp Med

Seborrheic dermatitis and butterfly rash in AIDS (letter)

N Engl J Med

Hematologic aspects of systemic lupus erythematosus

Ann Intern Med

Effects of mutations within the 3′ orf region of human T-cell lymphotropic virus type III on replication and cytopathogenicity

J Virol

Long-term cultures of HTLV-III infected T cells

Suppression of in vitro hematopoiesis following human immunodeficiency virus infection

Nature

Quantitation of B₂-microglobulin and other immune characteristics in a prospective study of men at risk for acquired immune deficiency syndrome

Acute neuropathy coincident with seroconversion for anti $LAV HTLV III$