Kaleidoscope of autoimmune diseases in HIV infection

Abstract

Within the last 30 years, the human immunodeficiency virus (HIV) infection has changed its status from inevitably fatal to chronic disorder with limited impact on life span. However, this breakthrough was mainly the effect of introduction of the aggressive antiviral treatment, which has led to the clinically significant increase in CD4+ cell count, resulting in fewer cases of the acquired immunodeficiency syndrome (AIDS) and improved management of opportunistic infections occurring in the course of the disease. The occurrence of a particular autoimmune disease depends on degree of immunosuppression of the HIV-positive patient. In 2002, four stages of autoimmunity were proposed in patients infected by HIV, based on the absolute CD4+ cell count, feature of AIDS as well as on the presence of autoimmune diseases. Spectrum of autoimmune diseases associated with HIV infection seems to be unexpectedly wide, involving several organs, such as lungs (sarcoidosis), thyroid gland (Graves' disease), liver (autoimmune hepatitis), connective tissue (systemic lupus erythematosus, rheumatoid arthritis, polyarteritis nodosa and other types of vasculitis, antiphospholipid syndrome) or hematopoietic system (autoimmune cytopenias). This paper contains the state of art on possible coincidences between HIV infection and a differential types of autoimmune diseases, including the potential mechanisms of this phenomenon. As the clinical manifestations of autoimmunization often mimic those inscribed in the course of HIV infection, health care providers should be aware of this rare but potentially deadly association and actively seek for its symptoms in their patients.

Prevalence of Skin-specific Autoantibodies in HIV-infected Patients and Uninfected Controls

“…T he spectrum of autoimmune phenomena in HIVinfected patients is unexpectedly broad and variable in the different stages of HIV infection and related to the immune system's imbalances associated with the retroviral infection (1,2). The likelihood of occurrence of autoimmune phenomena varies in the natural course of the HIV infection, but is particularly high in patients with a good immune status.…”

Analysis of the collagen fibers on autopsied patients’ uterus with the Acquired Immunodeficiency Syndrome

“…2 The imbalance between CD4 and CD8 cells seen in HIV infection can lead to alterations in the cytokine profiles with the reduction in anti-fibrotic cytokines mediated by a decrease of the interferon (IFN)-gamma from Th1 cells and an increase in the profibrotic cytokines (IL-4, IL-5, IL-10 and IL-13) due to a relative increase in the TH2 signal. 17,18 In addition to the infectious process, other factors may also alter the levels of cytokines in the genital fluids, such as oral contraceptive use, pregnancy, age and the use of vaginal antiseptics. 19 However, studies show that in chronic HIV infection, the epithelial cells, fibroblasts and the immune cells that reside in the female reproductive tract tissues contribute to the pool of cytokines, chemokines and growth factors present in the sexual hormones tissue environment, estradiol and progesterone.…”

Rapidly progressive melanoma differentiation–associated protein 5–positive amyopathic dermatomyositis in an HIV-positive patient

“…Treatment of autoimmune conditions, and dermatomyositis particularly, in the setting of HIV infection is challenging. Interestingly, hydroxychloroquine was reported to be safe and to even decrease HIV viral load; however, the use of immunosuppressive medications needs to be balanced against the potential increase in viral load and immunosuppression 15 . Future research is needed to better understand the pathogenesis and to guide the treatment decisions for autoimmune conditions in seropositive population.…”