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
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HIV infection has become a chronic disease and common rheumatologic diseases are encountered increasingly often in this setting
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The immune status of HIV-infected individuals, reflected by their CD4+ T-cell count, determines which rheumatologic diseases are likely to be encountered
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Diseases such as diffuse immune lymphocytosis syndrome are unique to HIV-infected individuals
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HIV-infected patients often develop other infections, which influence treatment decision making; biopsy and serology can assist diagnosis of these coexisting conditions
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Immunosuppressant drugs should be used with caution in HIV-infected patients
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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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References
WHO publication ISBN 9291735426. AIDS Epidemic Update: December 2006 [http://www.who.int/hiv/pub/epidemiology/epiupdate2006/en/index.html] (accessed 6 May 2008)
Winchester R et al. (1987) The co-occurrence of Reiter's syndrome and acquired immunodeficiency. Ann Intern Med 106: 19–26
Zandman-Goddard G and Shoenfeld Y (2002) HIV and autoimmunity. Autoimmun Rev 1: 329–337
Sempere JM et al. (2007) T regulatory cells and HIV infection. AIDS Rev 9: 54–60
Chinniah K et al. (2005) Arthritis in association with human immunodeficiency virus infection in black African children: causal or coincidental? Rheumatology (Oxford) 44: 915–920
Njobvu PD and McGill PE (1999) Is HIV the culprit? Spondyloarthropathy in the Third World. J Rheumatol 26: 2074–2075
Reveille JD et al. (1990) Human immunodeficiency virus-associated psoriasis, psoriatic arthritis, and Reiter's syndrome: a disease continuum? Arthritis Rheum 33: 1574–1578
Njobvu P and McGill P (2005) Human immunodeficiency virus related reactive arthritis in Zambia. J Rheumatol 32: 1299–1304
Gherardi RK (1994) Skeletal muscle involvement in HIV-infected patients. Neuropathol Appl Neurobiol 20: 232–237
Johnson RW et al. (2003) Human immunodeficiency virus-associated polymyositis: a longitudinal study of outcome. Arthritis Rheum 49: 172–178
Williams FM et al. (1998) Prevalence of the diffuse infiltrative lymphocytosis syndrome among human immunodeficiency virus type 1-positive outpatients. Arthritis Rheum 41: 863–868
Itescu S et al. (1989) A sicca syndrome in HIV infection: association with HLA-DR5 and CD8 lymphocytosis. Lancet 2: 466–468
Moulignier A et al. (1997) Peripheral neuropathy in human immunodeficiency virus-infected patients with the diffuse infiltrative lymphocytosis syndrome. Ann Neurol 41: 438–445
Authier FJ and Gherardi RK (2006) Muscular complications of human immunodeficiency virus (HIV) infection in the era of effective anti-retroviral therapy [French]. Rev Neurol (Paris) 162: 71–81
Schiodt M (1992) HIV-associated salivary gland disease: a review. Oral Surg Oral Med Oral Pathol 73: 164–167
Basu D et al. (2006) Changing spectrum of the diffuse infiltrative lymphocytosis syndrome. Arthritis Rheum 55: 466–472
Itescu S et al. (1993) Tissue infiltration in a CD8 lymphocytosis syndrome associated with human immunodeficiency virus-1 infection has the phenotypic appearance of an antigenically driven response. J Clin Invest 91: 2216–2225
Itescu S (1991) Diffuse infiltrative lymphocytosis syndrome in human immunodeficiency virus infection—a Sjögren's-like disease. Rheum Dis Clin North Am 17: 99–115
Guillevin L et al. (1997) The spectrum and treatment of virus-associated vasculitides. Curr Opin Rheumatol 9: 31–36
Chetty R et al. (2000) Large artery vasculopathy in HIV-positive patients: another vasculitic enigma. Hum Pathol 31: 374–379
Velez AP et al. (2006) Kawasaki-like syndrome possibly associated with immune reconstitution inflammatory syndrome in an HIV-positive patient. AIDS Read 16: 464–466
Katsetos CD et al. (1999) Angiocentric CD3+ T-cell infiltrates in human immunodeficiency virus type 1-associated central nervous system disease in children. Clin Diagn Lab Immunol 6: 105–114
Nguyen H et al. (2005) Churg–Strauss syndrome associated with HIV infection. J Am Board Fam Pract 18: 140–142
Hidaka H et al. (2003) Henoch–Schönlein purpura nephritis in a patient infected with the human immunodeficiency virus [Japanese]. Nippon Jinzo Gakkai Shi 45: 387–392
Cicalini S et al. (2004) Remission of Behçet's disease and keratoconjunctivitis sicca in an HIV-infected patient treated with HAART. Int J STD AIDS 15: 139–140
Gomez-Puerta JA et al. (2006) Behçet's disease in an HIV-1-infected patient treated with highly active antiretroviral therapy. Isr Med Assoc J 8: 513–514
Sekigawa I et al. (2002) Lessons from similarities between SLE and HIV infection. J Infect 44: 67–72
Ornstein MH et al. (1995) A reexamination of the relationship between active rheumatoid arthritis and the acquired immunodeficiency syndrome. Arthritis Rheum 38: 1701–1706
Munoz FS et al. (1991) Osteoarticular infection associated with the human immunodeficiency virus. Clin Exp Rheumatol 9: 489–493
Hirsch R et al. (1996) Human immunodeficiency virus-associated atypical mycobacterial skeletal infections. Semin Arthritis Rheum 25: 347–356
Jellis JE (2002) Human immunodeficiency virus and osteoarticular tuberculosis. Clin Orthop Relat Res 398: 27–31
Rajeswaran G et al. (2006) The radiology of IRIS (immune reconstitution inflammatory syndrome) in patients with mycobacterial tuberculosis and HIV co-infection: Appearances in 11 patients. Clin Radiol 61: 833–843
Calabrese LH et al. (2005) Rheumatic complications of human immunodeficiency virus infection in the era of highly active antiretroviral therapy: emergence of a new syndrome of immune reconstitution and changing patterns of disease. Semin Arthritis Rheum 35: 166–174
Helbert M et al. (1988) Zidovudine-associated myopathy. Lancet 2: 689–690
Florence E et al. (2002) Rheumatological complications associated with the use of indinavir and other protease inhibitors. Ann Rheum Dis 61: 82–84
Tebas P et al. (2000) Accelerated bone mineral loss in HIV-infected patients receiving potent antiretroviral therapy. AIDS 14: F63–F67
Sighinolfi L et al. (2000) Avascular necrosis of the femoral head: a side effect of highly active antiretroviral therapy (HAART) in HIV patients? Infection 28: 254–255
Falco M et al. (1993) Anti-cardiolipin antibodies in HIV infection are true antiphospholipids not associated with antiphospholipid syndrome. Ann Ital Med Int 8: 171–174
Kosmas N et al. (2006) Decreased prevalence of mixed cryoglobulinemia in the HAART era among HIV-positive, HCV-negative patients. J Med Virol 78: 1257–1261
Klaassen RJ et al. (1992) Anti-neutrophil cytoplasmic autoantibodies in patients with symptomatic HIV infection. Clin Exp Immunol 87: 24–30
Price P et al. (2001) Immune dysfunction and immune restoration disease in HIV patients given highly active antiretroviral therapy. J Clin Virol 22: 279–287
French MA and Price P (2001) Immune restoration disease in HIV-infected patients after antiretroviral therapy. Clin Infect Dis 32: 325–326
Shelburne SA III et al. (2002) Immune reconstitution inflammatory syndrome: emergence of a unique syndrome during highly active antiretroviral therapy. Medicine (Baltimore) 81: 213–227
French MA et al. (2004) Graves' disease during immune reconstitution after highly active antiretroviral therapy for HIV infection: evidence of thymic dysfunction. AIDS Res Hum Retroviruses 20: 157–162
Bourinbaiar AS and Lee-Huang S (1995) The non-steroidal anti-inflammatory drug, indomethacin, as an inhibitor of HIV replication. FEBS Lett 360: 85–88
Disla E et al. (1994) Improvement in CD4 lymphocyte count in HIV–Reiter's syndrome after treatment with sulfasalazine. J Rheumatol 21: 662–664
Chiang G et al. (1996) Inhibition of HIV-1 replication by hydroxychloroquine: mechanism of action and comparison with zidovudine. Clin Ther 18: 1080–1092
McComsey GA et al. (2001) Placebo-controlled trial of prednisone in advanced HIV-1 infection. AIDS 15: 321–327
Wallis RS et al. (2003) A study of the immunology, virology, and safety of prednisone in HIV-1-infected subjects with CD4 cell counts of 200 to 700 mm−3. J Acquir Immune Defic Syndr 32: 281–286
Sha BE et al. (2002) Effect of etanercept (Enbrel) on interleukin 6, tumor necrosis factor alpha, and markers of immune activation in HIV-infected subjects receiving interleukin 2. AIDS Res Hum Retroviruses 18: 661–665
Kaur PP et al. (2007) Successful etanercept use in an HIV-positive patient with rheumatoid arthritis. J Clin Rheumatol 13: 79–80
Aboulafia DM et al. (2000) Etanercept for the treatment of human immunodeficiency virus-associated psoriatic arthritis. Mayo Clin Proc 75: 1093–1098
Gaylis N (2003) Infliximab in the treatment of an HIV positive patient with Reiter's syndrome. J Rheumatol 30: 407–411
Bartke U et al. (2004) Human immunodeficiency virus-associated psoriasis and psoriatic arthritis treated with infliximab. Br J Dermatol 150: 784–786
Beltran B et al. (2006) Safe and effective application of anti-TNF-α in a patient infected with HIV and concomitant Crohn's disease. Gut 55: 1670–1671
Ahmad HN et al. (2004) Rituximab in chronic, recurrent HIV-associated immune thrombocytopenic purpura. Br J Haematol 127: 607–608
Schneider J and Zatarain E (2006) IRIS and SLE. Clin Immunol 118: 152–153
Diri E et al. (2000) Emergence of systemic lupus erythematosus after initiation of highly active antiretroviral therapy for human immunodeficiency virus infection. J Rheumatol 27: 2711–2714
Drake WP et al. (2003) Reactivation of systemic lupus erythematosus after initiation of highly active antiretroviral therapy for acquired immunodeficiency syndrome. J Clin Rheumatol 9: 176–180
Calza L et al. (2003) Systemic and discoid lupus erythematosus in HIV-infected patients treated with highly active antiretroviral therapy. Int J STD AIDS 14: 356–359
Calza L et al. (2004) Polymyositis associated with HIV infection during immune restoration induced by highly active anti-retroviral therapy. Clin Exp Rheumatol 22: 651–652
Sellier P et al. (2000) Human immunodeficiency virus-associated polymyositis during immune restoration with combination antiretroviral therapy. Am J Med 109: 510–512
Wegrzyn J et al. (2002) Rheumatoid arthritis after 9 years of human immunodeficiency virus infection: possible contribution of tritherapy. J Rheumatol 29: 2232–2234
Bell C et al. (2002) A case of immune reconstitution rheumatoid arthritis. Int J STD AIDS 13: 580–581
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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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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DOI: https://doi.org/10.1038/ncprheum0836
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