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Therapy Insight: the changing spectrum of rheumatic disease in HIV infection

Nature Clinical Practice Rheumatology volume 4, pages 428–438 (2008)Cite this article

Abstract

HIV infection and AIDS have protean and multisystem manifestations throughout the various stages of infection. Progression from HIV infection to AIDS is associated with a gradual loss of immunocompetence and the occurrence of opportunistic infections and malignancies; it is also associated with immune dysregulation and persistent, prolonged immune activation that leads to autoimmune phenomena such as vasculitis and serological abnormalities. In people who are infected with HIV, the recognition of autoinflammatory disorders, their differentiation from infections or lymphoproliferative malignancies and their treatment using potentially immunosuppressive drugs is a challenging clinical scenario. The spectrum of rheumatologic diseases reported in HIV-infected individuals has changed dramatically since the introduction of highly active antiretroviral therapy in 1995. Complications such as metabolic abnormalities, osteoporosis, and immune restoration inflammatory syndrome have emerged.

Key Points

  • HIV infection has become a chronic disease and common rheumatologic diseases are encountered increasingly often in this setting

  • The immune status of HIV-infected individuals, reflected by their CD4+ T-cell count, determines which rheumatologic diseases are likely to be encountered

  • Diseases such as diffuse immune lymphocytosis syndrome are unique to HIV-infected individuals

  • HIV-infected patients often develop other infections, which influence treatment decision making; biopsy and serology can assist diagnosis of these coexisting conditions

  • Immunosuppressant drugs should be used with caution in HIV-infected patients

  • Immune reconstitution inflammatory syndrome is a newly described entity wherein autoimmunity arises de novo or re-emerges with rising CD4+ T-cell counts and decreasing viral loads

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Figure 1: MRI scans of a patient with HIV-associated arthritis.
Figure 2: Keratoderma blenorrhagicum in a patient who has HIV with reactive arthritis.
Figure 3: Polymyositis associated with HIV infection.
Figure 4: Skeletal muscle biopsy specimen from a patient with HIV-associated polymyositis.
Figure 5: Parotid salivary gland enlargement in a patient with diffuse infiltrative lymphocytosis syndrome.
Figure 6: Minor salivary gland biopsy specimen from a patient with diffuse infiltrative lymphocytosis syndrome.

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Acknowledgements

The authors would like to acknowledge the support of the Thomas Street Directors—including TR Cate, MD (1989–1991), SM Miller (1991–1998), C Lehard, MD (1998–2005), and T Giordano, MD (2005–present)—throughout the period that their research was being carried out. The authors' work was supported by a grant from the University of Texas Health Science Center at Houston Clinical Research Center, and the Center for AIDS Research, Baylor College of Medicine.

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Authors and Affiliations

  1. JD Reveille is a Professor and the Director of the Division of Rheumatology, RM Maganti is a Fellow in Rheumatology, and FM Williams is a Clinical Assistant Professor at the University of Texas Health Science Center at Houston, TX, USA.,

    Rashmi M Maganti, John D Reveille & Frances M Williams

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  1. Rashmi M Maganti
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Correspondence to John D Reveille.

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The authors declare no competing financial interests.

Supplementary information

Supplementary Table 1

Worldwide distribution of rheumatic manifestations in HIV patients (DOC 79 kb)

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Maganti, R., Reveille, J. & Williams, F. Therapy Insight: the changing spectrum of rheumatic disease in HIV infection. Nat Rev Rheumatol 4, 428–438 (2008). https://doi.org/10.1038/ncprheum0836

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