HIV-Associated Systemic Sclerosis: Literature Review and a Rare Case Report

Abstract

Highly antiretroviral therapy (HAART) used in Human Immunodeficiency Virus (HIV) treatment may prolong the life span of people living with HIV/Acquired Immune Deficiency Syndrome (AIDS) but may also induce the onset of autoimmune disorders. However, HIV-associated systemic sclerosis (SSc) is an extremely rare occurrence, and only four case reports and two studies documenting this association have been reported to date. We report a rare case of HIV-associated SSc who was referred to us for pain management in her mandibular teeth. A 44-year-old female patient diagnosed with HIV-associated SSc reported a complaint of pain in the lower posterior teeth region. Physical examination revealed typical features of SSc. The pain in her mandibular teeth was due to food lodgement, and she was advised to use toothpaste with a powered toothbrush and mouth stretching exercises, followed by oral prophylaxis. The patient responded well to therapy. HIV-associated SSc is an extremely rare occurrence, with an obscure pathogenic mechanism of HIV-associated autoimmunity. Oral physicians play a crucial role in disease management and should be incorporated into the multidisciplinary team.

An unusual duo: Immunodeficiency disorder and scleroderma

“…Highly active antiretroviral therapy (HAART) has now made it possible to increase the longevity of the patients with HIV infection. [ 1 ] This HAART is now turning into a double-edged sword, and we see more reports on upsurge of reactivation of infections and autoimmune diseases in these patients. [ 2 ]…”

Advanced Therapies for Human Immunodeficiency Virus

“…In addition, ART has a dual effect on the immune system: ART diminishes the autoimmune response associated with chronic HIV infections, which manifests as immune activation, chronic inflammation and subsequent tissue damage. Conversely, ART can induce or exacerbate preexisting autoimmune conditions in the context of immune reconstitution which may lead to autoimmune thyroiditis, autoimmune hepatitis, systemic sclerosis or lupus-like syndromes [ 17 , 18 ]. Therefore, there is an important need for novel therapeutic approaches with curative potential or at least sustained viral suppression or immune reconstitution.…”