1
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Fernbach S, Mair NK, Abela IA, Groen K, Kuratli R, Lork M, Thorball CW, Bernasconi E, Filippidis P, Leuzinger K, Notter J, Rauch A, Hirsch HH, Huber M, Günthard HF, Fellay J, Kouyos RD, Hale BG. Loss of tolerance precedes triggering and lifelong persistence of pathogenic type I interferon autoantibodies. J Exp Med 2024; 221:e20240365. [PMID: 39017930 PMCID: PMC11253716 DOI: 10.1084/jem.20240365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 05/10/2024] [Accepted: 06/21/2024] [Indexed: 07/18/2024] Open
Abstract
Autoantibodies neutralizing type I interferons (IFN-Is) can underlie infection severity. Here, we trace the development of these autoantibodies at high-resolution using longitudinal samples from 1,876 well-treated individuals living with HIV over a 35-year period. Similar to general populations, ∼1.9% of individuals acquired anti-IFN-I autoantibodies as they aged (median onset ∼63 years). Once detected, anti-IFN-I autoantibodies persisted lifelong, and titers increased over decades. Individuals developed distinct neutralizing and non-neutralizing autoantibody repertoires at discrete times that selectively targeted combinations of IFNα, IFNβ, and IFNω. Emergence of neutralizing anti-IFNα autoantibodies correlated with reduced baseline IFN-stimulated gene levels and was associated with subsequent susceptibility to severe COVID-19 several years later. Retrospective measurements revealed enrichment of pre-existing autoreactivity against other autoantigens in individuals who later developed anti-IFN-I autoantibodies, and there was evidence for prior viral infections or increased IFN at the time of anti-IFN-I autoantibody triggering. These analyses suggest that age-related loss of self-tolerance prior to IFN-I immune-triggering poses a risk of developing lifelong functional IFN-I deficiency.
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Affiliation(s)
- Sonja Fernbach
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Nina K. Mair
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Irene A. Abela
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Kevin Groen
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Roger Kuratli
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Marie Lork
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Christian W. Thorball
- Precision Medicine Unit, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Enos Bernasconi
- Division of Infectious Diseases, Ente Ospedaliero Cantonale Lugano, University of Geneva and University of Southern Switzerland, Lugano, Switzerland
| | - Paraskevas Filippidis
- Department of Medicine, Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | | | - Julia Notter
- Division of Infectious Diseases, Infection Prevention and Travel Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Andri Rauch
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hans H. Hirsch
- Department of Biomedicine, Transplantation and Clinical Virology, University of Basel, Basel, Switzerland
| | - Michael Huber
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Huldrych F. Günthard
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jacques Fellay
- Precision Medicine Unit, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- School of Life Sciences, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Roger D. Kouyos
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Benjamin G. Hale
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
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2
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Baima JPS, Silva BCG, Vieira VL, Meireles LP, Arai MH, Lino AMM. A great simulator in clinical practice: mononeuritis multiplex in HIV infection. Autops Case Rep 2024; 14:e2024493. [PMID: 39021464 PMCID: PMC11253905 DOI: 10.4322/acr.2024.493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 04/21/2024] [Indexed: 07/20/2024]
Abstract
HIV infection is a chameleon, mimicking several diseases. Herein, we report a previously healthy 39-year-old woman who, over 2 months, developed arthritis, weight loss, and confluent multiple mononeuropathy. Extensive laboratory investigation showed positive serology for HIV, with a CD4 count of 100 cells, and necrotizing vasculitis on a nerve biopsy not associated with CMV co-infection, allowing the diagnosis of polyarteritis nodosa-like vasculitis in an HIV-infected patient. Apart from the infection, HIV-related autoimmunity can affect any organ and contribute to the complexity of the clinical presentation of HIV infection.
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Affiliation(s)
- José Pedro Soares Baima
- Universidade de São Paulo (USP), Hospital das Clínicas, Faculdade de Medicina, Departamento de Neurologia, São Paulo, SP, Brasil
| | - Beatriz Carneiro Gondim Silva
- Universidade de São Paulo (USP), Hospital das Clínicas, Faculdade de Medicina, Departamento de Neurologia, São Paulo, SP, Brasil
| | - Vanessa Lopes Vieira
- Universidade de São Paulo (USP), Hospital das Clínicas, Faculdade de Medicina, Departamento de Medicina Interna, São Paulo, SP, Brasil
| | - Luiz Pedro Meireles
- Universidade de São Paulo (USP), Hospital das Clínicas, Faculdade de Medicina, Departamento de Medicina Interna, São Paulo, SP, Brasil
| | - Milton Hideaki Arai
- Universidade de São Paulo (USP), Hospital das Clínicas, Faculdade de Medicina, Departamento de Medicina Interna, São Paulo, SP, Brasil
| | - Angelina Maria Martins Lino
- Universidade de São Paulo (USP), Hospital das Clínicas, Faculdade de Medicina, Departamento de Neurologia, São Paulo, SP, Brasil
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3
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Fujishima N, Hioki Y, Yokoyama A, Hiramatsu K, Komiya K. Pneumocystis Pneumonia Presenting With Peripheral Predominant Consolidation and Traction Bronchiectasis. Cureus 2024; 16:e63257. [PMID: 39070459 PMCID: PMC11282382 DOI: 10.7759/cureus.63257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2024] [Indexed: 07/30/2024] Open
Abstract
Pneumocystis jirovecii pneumonia (PCP) typically presents as a predominant ground-glass opacity (GGO) in the upper lobes. We report a case of a patient with PCP that mimicked organizing pneumonia or nonspecific interstitial pneumonia, showing peripheral predominant consolidation with traction bronchiectasis and peribronchovascular thickening in the lower lobes on high-resolution computed tomography (HRCT). Pneumocystis jirovecii was detected in bronchoalveolar lavage (BAL), and no other pathogens were isolated. After confirmation of a high plasma human immunodeficiency virus (HIV)-RNA titer and a low CD4+ cell count, the patient was diagnosed with PCP associated with HIV infection. The peripheral predominant consolidation was successfully resolved after treatment with trimethoprim-sulfamethoxazole. To the best of our knowledge, no previous case of PCP presenting with peripheral predominant consolidation, traction bronchiectasis, or peribronchovascular thickening has been reported. Physicians should consider PCP as a differential diagnosis even in cases suspected as organizing pneumonia or nonspecific interstitial pneumonia on HRCT.
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Affiliation(s)
- Nobuhiro Fujishima
- Respiratory Medicine and Infectious Diseases, Oita University, Yufu, JPN
| | - Yoshihide Hioki
- Respiratory Medicine and Infectious Diseases, Oita University, Yufu, JPN
| | - Atsushi Yokoyama
- Respiratory Medicine and Infectious Diseases, Oita University, Yufu, JPN
| | - Kazufumi Hiramatsu
- Respiratory Medicine and Infectious Diseases, Oita University, Yufu, JPN
| | - Kosaku Komiya
- Respiratory Medicine and Infectious Diseases, Oita University, Yufu, JPN
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4
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Okubo S, Mano T, Sudo A, Goto R, Yano S, Hara M, Ishiura H, Satake W, Yanagimoto S, Ogata H, Toda T. Anti-neurofascin 155 Antibody-positive Neuropathy in a Human Immunodeficiency Virus-infected Patient. Intern Med 2024; 63:565-569. [PMID: 37380455 PMCID: PMC10937119 DOI: 10.2169/internalmedicine.1919-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 05/22/2023] [Indexed: 06/30/2023] Open
Abstract
Human immunodeficiency virus (HIV)-associated neuropathy is a common complication of HIV infection and has several clinical subtypes. HIV-associated chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a demyelinating neuropathy whose clinical features are known to differ from those of CIDP in the HIV-uninfected population. We herein report a case of CIDP in an HIV-infected patient who was finally diagnosed with anti-neurofascin 155 (NF155) antibody-positive neuropathy. The clinical features, including clinical findings and therapeutic responses, were typical of paranodal antibody-mediated neuropathy. To our knowledge, this is the first case of anti-NF155 antibody-associated neuropathy in an HIV-infected patient.
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Affiliation(s)
- So Okubo
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Tatsuo Mano
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Atsushi Sudo
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Ryoji Goto
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Satoka Yano
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Manato Hara
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Hiroyuki Ishiura
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Wataru Satake
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Shintaro Yanagimoto
- Department of Infectious Disease, Graduate School of Medicine, The University of Tokyo, Japan
| | - Hidenori Ogata
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Tatsushi Toda
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Japan
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5
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Tada Y, Kaya H, Shima K. [A case of neuromyelitis optica spectrum disorder after human immunodeficiency virus infection treated with rituximab]. Rinsho Shinkeigaku 2023; 63:748-753. [PMID: 37880114 DOI: 10.5692/clinicalneurol.cn-001891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
The patient was a 58-year-old Japanese man. At age 52 years, he was diagnosed with human immunodeficiency virus (HIV) infection and had been receiving highly active antiretroviral therapy (HAART). He presented to the emergency department with acute upper left and right lower extremity paralysis. Spinal cord magnetic resonance imaging showed intramedullary signal changes over three vertebral bodies in the cervical spinal cord. Anti-aquaporin-4 antibody was positive in serum, and neuromyelitis optica spectrum disorder (NMOSD) was diagnosed. Steroid pulse therapy and plasma exchange were performed but had limited effects. In Japan, there is no report of NMOSD after HIV infection treated with rituximab. Rituximab administration should be considered in refractory cases of NMOSD after HIV infection.
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Affiliation(s)
- Yasutake Tada
- Department of Neurology, Toyama Prefectural Central Hospital
| | - Hiroyasu Kaya
- Department of Infectious Diseases, Toyama Prefectural Central Hospital
| | - Keisuke Shima
- Department of Neurology, Toyama Prefectural Central Hospital
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6
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Khoo T, Lilleker JB, Thong BYH, Leclair V, Lamb JA, Chinoy H. Epidemiology of the idiopathic inflammatory myopathies. Nat Rev Rheumatol 2023; 19:695-712. [PMID: 37803078 DOI: 10.1038/s41584-023-01033-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2023] [Indexed: 10/08/2023]
Abstract
The idiopathic inflammatory myopathies (IIMs) are a heterogeneous group of systemic autoimmune diseases that affect the skeletal muscles and can also involve the skin, joints, lungs and heart. The epidemiology of IIM is obscured by changing classification criteria and the inherent shortcomings of case identification using healthcare record diagnostic coding. The incidence of IIM is estimated to range from 0.2 to 2 per 100,000 person-years, with prevalence from 2 to 25 per 100,000 people. Although the effects of age and gender on incidence are known, there is only sparse understanding of ethnic differences, particularly in indigenous populations. The incidence of IIM has reportedly increased in the twenty-first century, but whether this is a genuine increase is not yet known. Understanding of the genetic risk factors for different IIM subtypes has advanced considerably. Infections, medications, malignancy and geography are also commonly identified risk factors. Potentially, the COVID-19 pandemic has altered IIM incidence, although evidence of this occurrence is limited to case reports and small case series. Consideration of the current understanding of the epidemiology of IIM can highlight important areas of interest for future research into these rare diseases.
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Affiliation(s)
- Thomas Khoo
- Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- School of Medicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Department of Rheumatology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK
| | - James B Lilleker
- Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Manchester Centre for Clinical Neuroscience, Manchester Academic Health Science Centre, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Bernard Yu-Hor Thong
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Valérie Leclair
- Department of Medicine, Division of Rheumatology, McGill University, Montreal, Canada
| | - Janine A Lamb
- Epidemiology and Public Health Group, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Hector Chinoy
- Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
- Department of Rheumatology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK.
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Nosik M, Belikova MG, Ryzhov K, Avdoshina D, Sobkin A, Zverev V, Svitich O. Unique Profile of Proinflammatory Cytokines in Plasma of Drug-Naïve Individuals with Advanced HIV/TB Co-Infection. Viruses 2023; 15:1330. [PMID: 37376629 DOI: 10.3390/v15061330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/23/2023] [Accepted: 05/25/2023] [Indexed: 06/29/2023] Open
Abstract
HIV-1 infection is characterized by aberrant immune activation, and infection with M. tuberculosis by an unbalanced production of proinflammatory cytokines. The expression of these cytokines in HIV-1/TB coinfection is still understudied. Here, we aimed to compare the production of proinflammatory cytokines in drug-naive patients coinfected with HIV-1 and M. tuberculosis (HIV/TB) compared to patients with respective monoinfections. Plasma samples of patients with HIV/TB coinfection (n = 36), HIV-1 monoinfection (n = 36), and TB monoinfection (n = 35) and healthy donors (n = 36) were examined for the levels of eight proinflammatory cytokines. Their levels were significantly increased in all patient groups compared to healthy donors. At the same time, a drastic decrease in the plasma levels of IFN-γ, TNF-α, Il-1β, IL-15, and IL-17 was detected in patients with HIV/TB coinfection compared to patients with HIV-1 or TB monoinfections. The plasma levels of IL-17 characterized the TB severity: in HIV/TB-coinfected patients with disseminated TB, plasma levels of IL-17 were eight times lower than in patients with less severe TB forms (infiltrative TB or TB of intrathoracic lymph nodes; p < 0.0001). At the same time, HIV/TB-coinfected patients had increased plasma levels of IL-8, IL-12, and IL-18, with the levels of IL-8 correlating with mortality (p < 0.0001). Thus, on the contrary to the patients with HIV-1 or TB monoinfections, HIV/TB-coinfected patients had suppressed production of most of the proinflammatory cytokines associated with antimicrobial immune response, specifically of T-cells involved in the containment of both infections. At the same time, they demonstrated an expansion of proinflammatory cytokines known to originate from both hematopoietic and nonhematopoietic cells, and manifest tissue inflammation. In HIV-1/TB coinfection, this leads to the disruption of granuloma formation, contributing to bacterial dissemination and enhancing morbidity and mortality.
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Affiliation(s)
- Marina Nosik
- I.I. Mechnikov Institute of Vaccine and Sera, 105064 Moscow, Russia
| | - Maria G Belikova
- N.F. Gamaleya National Research Center for Epidemiology and Microbiology, 123098 Moscow, Russia
- Chumakov Federal Scientific Center for Research and Development of Immune-and-Biological Products, Russian Academy of Sciences, 108819 Moscow, Russia
- Translational Medicine Cluster, Peoples' Friendship University of Russia, 117198 Moscow, Russia
| | | | - Darya Avdoshina
- Chumakov Federal Scientific Center for Research and Development of Immune-and-Biological Products, Russian Academy of Sciences, 108819 Moscow, Russia
| | - Alexandr Sobkin
- Department for Treatment of TB Patients with HIV Infection, G.A. Zaharyan Moscow Tuberculosis Clinic, 125466 Moscow, Russia
| | - Vitaly Zverev
- I.I. Mechnikov Institute of Vaccine and Sera, 105064 Moscow, Russia
| | - Oxana Svitich
- I.I. Mechnikov Institute of Vaccine and Sera, 105064 Moscow, Russia
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8
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Morales DR, Moreno-Martos D, Matin N, McGettigan P. Health conditions in adults with HIV compared with the general population: A population-based cross-sectional analysis. EClinicalMedicine 2022; 47:101392. [PMID: 35497059 PMCID: PMC9046106 DOI: 10.1016/j.eclinm.2022.101392] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/21/2022] [Accepted: 03/28/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Life expectancy in adults with human immunodeficiency virus (HIV) has increased and managing other health conditions is increasingly important for patients and healthcare planning. The aim of this study was to examine the prevalence and association between different health conditions and HIV status. METHODS We performed a cross-sectional analysis of adult UK Clinical Practice Research Datalink primary care electronic medical records linked to hospital admissions as of Nov 30, 2015. We examined 47 health condition groups and 304 physical and mental health conditions by HIV status, after adjustment for age, sex, social deprivation status using logistic regression. FINDINGS There were 964 patients with HIV (61.7% male; 92.8% aged <65 years) and 941,113 non-HIV patients (49.4% male; 75.2% aged <65 years). Condition groups with the greatest prevalence in HIV that were also highly prevalent in adults without HIV included: lipid disorder (41.4% vs 40.2%), and hypertension (19.1% vs 24.6%). Following adjustment, 18 (37.5%) condition groups were more likely in adults with HIV and ten (20.8%) were less likely. Individual conditions that were less likely in adults with HIV included: atrial fibrillation (odds ratio [OR] 0.37 [95% CI 0.20-0.64]) and hypertension (OR_0.78 [0.65-0.94]); rheumatoid arthritis (OR 0.27 [0.05-0.84]); asthma (OR_0.65 (0.53-0.80]); and certain eye diseases such as macular degeneration (OR_0.30 [0.09-0.70]). Meanwhile individual conditions that were more likely included: liver fibrosis, sclerosis, and cirrhosis (OR_3.23 [1.85-5.20]); pulmonary embolism (OR_2.06 [1.15-3.36]); male infertility (OR_2.23 [1.50-3.16]) and female infertility (OR_2.01 [1.34-2.88]); bipolar disorder (OR_2.93 [1.52-5.05]) and depression (OR_1.49 [1.28-1.71]); cervical malignancy (OR_4.64 [1.15-12.15]); and infections. INTERPRETATION Comorbidity is common in adults with HIV, with physical and mental health conditions spanning a wide spectrum. HIV management should consider multidisciplinary care models to provide optimal patient care. FUNDING The project was funded by the Bart's Charity; DRM was funded by a Wellcome Trust Clinical Research Career Development Fellowship; DRM and DMM received funding from the HDR-UK Precision therapeutics programme.
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Affiliation(s)
- Daniel R. Morales
- Division of Population Health and Genomics, University of Dundee, Dundee, United Kingdom
- Department of Public Health, University of Southern Denmark, Denmark
- Corresponding author at: Division of Population Health and Genomics, University of Dundee, Dundee, United Kingdom.
| | - David Moreno-Martos
- Division of Population Health and Genomics, University of Dundee, United Kingdom
| | - Nashaba Matin
- Barts Health NHS Trust, Grahame Hayton Unit, Royal London Hospital, London, United Kingdom
| | - Patricia McGettigan
- William Harvey Research Institute, Queen Mary University of London, United Kingdom
- Corresponding author.
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9
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Micali C, Russotto Y, Caci G, Ceccarelli M, Marino A, Celesia BM, Pellicanò GF, Nunnari G, Venanzi Rullo E. Loco-Regional Treatments for Hepatocellular Carcinoma in People Living with HIV. Infect Dis Rep 2022; 14:43-55. [PMID: 35076514 PMCID: PMC8788283 DOI: 10.3390/idr14010006] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/03/2022] [Accepted: 01/04/2022] [Indexed: 02/05/2023] Open
Abstract
Hepatocellular carcinoma (HCC) accounts for approximately 75–90% of primary liver cancers and is the sixth most common cancer and the third leading cause of cancer-related deaths worldwide. In the HIV-positive population, the risk of HCC is approximately four times higher than in the general population, with higher cancer-specific mortality than in HIV-negative patients. In most cases, HCC diagnosis is made in patients younger than the HIV-negative population and in the intermediate-advanced stage, thus limiting the therapeutic possibilities. Treatment choice in HIV-positive patients with HCC is subject to cancer staging, liver function and health status, as for HIV-negative and non-HIV-negative HCC patients. There are relatively few studies on the efficacy and safety in HIV-positive patients to date in loco-regional treatments for HCC. So far, literature shows that curative treatments such as radiofrequency ablation (RFA) have no significant differences in overall survival between HIV-positive and HIV-negative patients, as opposed to palliative treatments such as TACE, where there is a significant difference in overall survival. Although it can be assumed that the most recently discovered loco-regional therapies are applicable to HIV-positive patients with HCC in the same way as HIV-negative patients, further studies are needed to confirm this hypothesis. The purpose of our review is to evaluate these treatments, their efficacy, effectiveness, safety and their applicability to HIV-positive patients.
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Affiliation(s)
- Cristina Micali
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina, 98124 Messina, Italy; (Y.R.); (G.C.); (G.N.); (E.V.R.)
- Correspondence: ; Tel.: +39-090-2212032
| | - Ylenia Russotto
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina, 98124 Messina, Italy; (Y.R.); (G.C.); (G.N.); (E.V.R.)
| | - Grazia Caci
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina, 98124 Messina, Italy; (Y.R.); (G.C.); (G.N.); (E.V.R.)
| | - Manuela Ceccarelli
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Catania, 95131 Catania, Italy; (M.C.); (A.M.); (B.M.C.)
- Unit of Infectious Diseases, Department of Biomedical, Dental, Morphological and Functional Imaging Sciences, University of Messina, 98124 Messina, Italy
| | - Andrea Marino
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Catania, 95131 Catania, Italy; (M.C.); (A.M.); (B.M.C.)
| | - Benedetto Maurizio Celesia
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Catania, 95131 Catania, Italy; (M.C.); (A.M.); (B.M.C.)
| | - Giovanni Francesco Pellicanò
- Unit of Infectious Diseases, Department of Adult and Childhood Human Pathology “Gaetano Barresi”, University of Messina, 98124 Messina, Italy;
| | - Giuseppe Nunnari
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina, 98124 Messina, Italy; (Y.R.); (G.C.); (G.N.); (E.V.R.)
| | - Emmanuele Venanzi Rullo
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina, 98124 Messina, Italy; (Y.R.); (G.C.); (G.N.); (E.V.R.)
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10
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Patra P, Samal P, Bhola R, Pradhan S. An event of Evans even in HIV. Indian J Sex Transm Dis AIDS 2022; 43:64-66. [PMID: 35846539 PMCID: PMC9282701 DOI: 10.4103/ijstd.ijstd_113_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 05/05/2021] [Accepted: 05/05/2021] [Indexed: 11/28/2022] Open
Abstract
Autoimmune cytopenias may be the initial presentation in patients with HIV infection or can develop while on treatment with antiretroviral therapy (ART). These cytopenias usually resolve after initiation of ART. We report a rare case of HIV who presented with Evans syndrome on ART, being refractory to steroids and rituximab but with response to splenectomy.
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11
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Reitermaier R, Skoll M, Touzeau-Roemer V, Aichelburg MC, Elbe-Bürger A, Bauer W, Rieger A, Schuster C. Frequency of Envoplakin and Type VII Collagen Autoantibodies and Co-occurrence with Other Skin-specific Autoantibodies in HIV-infected Patients and Uninfected Controls. Acta Derm Venereol 2021; 101:adv00601. [PMID: 34694419 PMCID: PMC9455334 DOI: 10.2340/actadv.v101.440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | - Christopher Schuster
- Department of Dermatology, Medical University of Vienna, Waehringer Guertel 18-20, AT-1090 Vienna, Austria.
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12
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Fiorino S, Tateo F, Biase DD, Gallo CG, Orlandi PE, Corazza I, Budriesi R, Micucci M, Visani M, Loggi E, Hong W, Pica R, Lari F, Zippi M. SARS-CoV-2: lessons from both the history of medicine and from the biological behavior of other well-known viruses. Future Microbiol 2021; 16:1105-1133. [PMID: 34468163 PMCID: PMC8412036 DOI: 10.2217/fmb-2021-0064] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 07/22/2021] [Indexed: 02/07/2023] Open
Abstract
SARS-CoV-2 is the etiological agent of the current pandemic worldwide and its associated disease COVID-19. In this review, we have analyzed SARS-CoV-2 characteristics and those ones of other well-known RNA viruses viz. HIV, HCV and Influenza viruses, collecting their historical data, clinical manifestations and pathogenetic mechanisms. The aim of the work is obtaining useful insights and lessons for a better understanding of SARS-CoV-2. These pathogens present a distinct mode of transmission, as SARS-CoV-2 and Influenza viruses are airborne, whereas HIV and HCV are bloodborne. However, these viruses exhibit some potential similar clinical manifestations and pathogenetic mechanisms and their understanding may contribute to establishing preventive measures and new therapies against SARS-CoV-2.
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Affiliation(s)
- Sirio Fiorino
- Internal Medicine Unit, Budrio Hospital, Budrio (Bologna), Azienda USL, Bologna, 40054, Italy
| | - Fabio Tateo
- Institute of Geosciences & Earth Resources, CNR, c/o Department of Geosciences, Padova University, 35127, Italy
| | - Dario De Biase
- Department of Pharmacy & Biotechnology, University of Bologna, Bologna, 40126, Italy
| | - Claudio G Gallo
- Fisiolaserterapico Emiliano, Castel San Pietro Terme, Bologna, 40024, Italy
| | | | - Ivan Corazza
- Department of Experimental, Diagnostic & Specialty Medicine, University of Bologna, Bologna, 40126, Italy
| | - Roberta Budriesi
- Department of Pharmacy & Biotechnology, Alma Mater Studiorum-University of Bologna, Bologna, 40126, Italy
| | - Matteo Micucci
- Department of Pharmacy & Biotechnology, Alma Mater Studiorum-University of Bologna, Bologna, 40126, Italy
| | - Michela Visani
- Department of Pharmacy & Biotechnology, University of Bologna, Bologna, 40126, Italy
| | - Elisabetta Loggi
- Hepatology Unit, Department of Medical & Surgical Sciences, University of Bologna, Bologna, 40126, Italy
| | - Wandong Hong
- Department of Gastroenterology & Hepatology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou City, Zhejiang, 325035, PR China
| | - Roberta Pica
- Unit of Gastroenterology & Digestive Endoscopy, Sandro Pertini Hospital, Rome, 00157, Italy
| | - Federico Lari
- Internal Medicine Unit, Budrio Hospital, Budrio (Bologna), Azienda USL, Bologna, 40054, Italy
| | - Maddalena Zippi
- Unit of Gastroenterology & Digestive Endoscopy, Sandro Pertini Hospital, Rome, 00157, Italy
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Hanberg JS, Hsieh E, Akgün KM, Weinstein E, Fraenkel L, Justice AC. Incident Rheumatoid Arthritis in Human Immunodeficiency Virus Infection: Epidemiology and Treatment. Arthritis Rheumatol 2021; 73:2189-2199. [PMID: 34042306 DOI: 10.1002/art.41802] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 05/04/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To assess the incidence, presentation, and management of RA in persons with HIV (PWH), including use of disease-modifying anti-rheumatic drugs (DMARDs) in this immunosuppressed population. METHODS Patients were included from the Veterans Aging Cohort Study, a longitudinal cohort of Veterans with HIV and matched uninfected Veterans. We identified patients with ≥1 rheumatologist-generated International Classification of Diseases (ICD) code for RA and a measurement of rheumatoid factor (RF) or anti-CCP antibodies. Charts were reviewed using the 2010 RA Classification Criteria to identify incident RA. We recorded use and adverse effects of DMARDs during the first contiguous (no interruption greater than 6 months) course. RESULTS We included 56,250 PWH and 116,944 uninfected persons over 2,384,541 person-years. Of 2,748 patients with an RA ICD code, incident RA was identified in 215 patients, including 21 PWH. The incidence rate ratio of RA in PWH vs. uninfected was 0.29 (95% CI 0.19-0.48). Most patients (88%) with RA were seropositive. However, high autoantibody titers were less common in PWH: 5% (1/21) of PWH had both high titer anti-CCP and RF, compared to 41% (82/194) of uninfected. DMARDs were prescribed for 71% (15/21) of PWH with RA, compared to 94% (183/194) of uninfected. Among 10 PWH prescribed DMARDs, we found no signal for worse infectious safety profile compared to 158 HIV-negative controls. CONCLUSION Incident RA was less common in PWH than in matched controls. PWH with incident RA had less positive autoantibody profiles than controls and were prescribed DMARDs less frequently.
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Affiliation(s)
- Jennifer S Hanberg
- Department of Medicine, Yale University School of Medicine, New Haven, CT, and VA Connecticut Healthcare System, West Haven, CT, USA
| | - Evelyn Hsieh
- Department of Medicine, Yale University School of Medicine, New Haven, CT, and VA Connecticut Healthcare System, West Haven, CT, USA.,Section of Rheumatology, Yale University School of Medicine, New Haven, CT, USA
| | - Kathleen M Akgün
- Department of Medicine, Yale University School of Medicine, New Haven, CT, and VA Connecticut Healthcare System, West Haven, CT, USA
| | - Erica Weinstein
- Division of Infectious Diseases and Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Liana Fraenkel
- Department of Medicine, Yale University School of Medicine, New Haven, CT, and VA Connecticut Healthcare System, West Haven, CT, USA.,Section of Rheumatology, Yale University School of Medicine, New Haven, CT, USA
| | - Amy C Justice
- Department of Medicine, Yale University School of Medicine, New Haven, CT, and VA Connecticut Healthcare System, West Haven, CT, USA.,Yale University School of Public Health, New Haven, CT, USA
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14
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Sinit RB, Leung JH, Hwang WS, Woo JS, Aboulafia DM. An Unusual Case of Hashimoto's Thyroiditis Presenting as Impending Cardiac Tamponade in a Patient with Acquired Immune Deficiency Syndrome (AIDS). AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e929249. [PMID: 34039947 PMCID: PMC8165493 DOI: 10.12659/ajcr.929249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Patient: Male, 52-year-old Final Diagnosis: Hashimoto’s thyroiditis Symptoms: Acute epigastric pain • confusion • diarrhea • episodic gastrointestinal discomfort • fatigue • nausea • vomiting Medication: — Clinical Procedure: Radiographic-assisted pericardiocentesis Specialty: Hematology
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Affiliation(s)
- Ryan B Sinit
- Section of Hematology and Oncology, Virginia Mason Medical Center, Seattle, WA, USA
| | - Janet H Leung
- Department of Endocrinology, Virginia Mason Medical Center, Seattle, WA, USA.,Department of Transgender Health, Virginia Mason Medical Center, Seattle, WA, USA
| | - Wayne S Hwang
- Department of Cardiology, Virginia Mason Medical Center, Seattle, WA, USA
| | - J Susie Woo
- Department of Cardiology, Virginia Mason Medical Center, Seattle, WA, USA
| | - David M Aboulafia
- Section of Hematology and Oncology, Virginia Mason Medical Center, Seattle, WA, USA.,Division of Hematology, University of Washington School of Medicine, Seattle, WA, USA
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15
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Morgunova TB, Zorina AA, Maloletkina ES, Sytch YP, Vasileva AV, Fadeyev VV. [Graves' disease in HIV patient receiving antiretroviral therapy]. ACTA ACUST UNITED AC 2020; 66:22-26. [PMID: 33351335 DOI: 10.14341/probl12375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/14/2020] [Accepted: 07/06/2020] [Indexed: 11/06/2022]
Abstract
The article focuses on the clinical case of Graves’ disease in a patient with HIV infection who is receiving antiretroviral therapy. The number of HIV-infected patients has increased significantly in recent decades all over the world. The currently used highly active antiretroviral therapy can significantly improve the prognosis for these patients. However, its use is associated with a number of complications, in particular the development of immune reconstitution syndrome, under which the development of such autoimmune diseases as Graves’ disease, polymyositis and Guillain-Barre syndrome may occur. Therefore, we would like to draw the attention of doctors to the possibility of such a complication in patients receiving antiretroviral therapy. Timely diagnosis and treatment of thyroid disorders will help to avoid the complications associated with an excess or deficit of thyroid hormones.
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Affiliation(s)
| | - Anastasia A Zorina
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | | | - Yulia P Sytch
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - Ariadna V Vasileva
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - Valentin V Fadeyev
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
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16
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Abstract
Purpose of Review To review the spectrum of vasculitides in HIV-infected patients and to identify the clinical features that characterize vasculitis in sero-positive HIV. Recent Findings Epidemiological studies conducted in the post-HAART era described the rarity of vasculitis in the setting of HIV-infected patients. A study identified histopathological features such as leukocytoclastic vasculitis of the vasa vasorum and adventitial inflammation in the large artery pathology of HIV-positive patients compared with HIV-negative patients with critical lower limb ischemia. A recent retrospective cohort study reported that HIV-positive patients with LVV developed more vascular complications, responded less to antiretroviral therapy, and had worse outcome than HIV-negative patients with LVV. Summary Vasculitides continue to be a rare disease in patients with HIV. The spectrum of vasculitis ranges from life-threatening conditions to relatively mild skin conditions. Recognizing vasculitis in the setting of HIV-positive patients is important because sometimes it require immunosuppressive treatment.
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Affiliation(s)
- Luis E Vega
- Section of Rheumatology, Air Force Central Hospital, Aramburú Ave 2nd block, Lima, Peru.
| | - Luis R Espinoza
- Louisiana State University Health Sciences Center, 433 Bolivar St, New Orleans, LA, 70112, USA
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17
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Nadir CD4 Is Negatively Associated With Antinuclear Antibody Detection in HCV/HIV-Coinfected Patients. J Acquir Immune Defic Syndr 2019; 80:461-466. [PMID: 30570526 DOI: 10.1097/qai.0000000000001940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hepatitis C virus (HCV) and HIV infections are associated with higher risk of autoimmune diseases and T-cell dysfunction. SETTING We evaluate prevalence and factors associated with the presence of autoimmune antinuclear (ANA), anti-smooth muscle actin (aSMA), and anti-liver kidney microsome (aLKM1) antibodies (Ab) in HCV/HIV-coinfected patients during the post-combined antiretroviral therapy era. METHODS A cross-sectional observational study nested in the ANRS CO13 HEPAVIH cohort (NCT number: NCT03324633). We selected patients with both ANA testing and T-cell immunophenotyping determination during the cohort follow-up and collected aLKM1 and aSMA data when available. Logistic regression models were built to determine factors associated with the presence of auto-Ab. RESULTS Two hundred twenty-three HCV/HIV-coinfected patients fulfilled selection criteria. Prevalence of ANA and aSMA was 43.5% and 23.2%, respectively, and both were detected in 13.3% of patients. Isolated aSMA were detected in 9.9% and aLKM1 in 2 patients. In multivariable analysis, only a low nadir CD4 T-cell count was significantly associated with ANA detection. CONCLUSIONS ANA and aSMA detection remain frequent in HCV/HIV-coinfected patients during the post-combined antiretroviral therapy era, despite fair immune restoration. These results advocate for a close monitoring of ANA before immune checkpoint inhibitor therapy in these patients with greater caution for those with a low nadir CD4 T-cell count.
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18
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Contributing awareness of autoimmune hepatitis in HIV patients. AIDS 2019; 33:2103-2105. [PMID: 31577575 DOI: 10.1097/qad.0000000000002299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Silvestri V, Borrazzo C, Mele R, d'Ettorre G. Carotid Artery Aneurysm in HIV: A Review of Case Reports in Literature. Ann Vasc Surg 2019; 63:409-426. [PMID: 31629845 DOI: 10.1016/j.avsg.2019.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 08/23/2019] [Accepted: 09/15/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND HIV infection may affect the cardiovascular system through different physiopathological patterns. Rarely reported in HIV negative patients, aneurysms involving the carotid artery have been described for the first time in seropositive patients in 1989. AIMS In our study, we have focused on aneurysm pathology affecting carotid arteries in HIV patients, analyzing clinical and surgical presentation, management, and outcome, through a review of cases published in the literature. METHODS The MEDLINE (www.ncbi.nlm.nih.gov/pubmed) database was reviewed for "carotid artery aneurysm AND HIV OR AIDS OR immunodeficiency." RESULTS Nineteen articles including a total of 46 cases were included in our report. The mean age of patients was 30.6 ± 14.2 years; 30 patients (65.2%) were male. Aneurysms were localized in the intracranial carotid (41.3%) or extracranial artery (58%). Presenting features included symptoms due to compression of neck structures; positivity for neurological symptoms occurred in 36.9%. Patients were managed surgically in 58.7% of cases; surgical morbidity and mortality were of 22.2% and 7.4% respectively, higher for endovascular procedures. The overall mortality in treated and untreated cases was 26.1%. CONCLUSIONS Aneurysms may occur in both the extracranial and intracranial carotid artery in patients with HIV at younger age than in non-HIV patients and are linked to a high morbidity and mortality. Seropositivity must be ruled out whenever this rare vascular condition may occur in the absence of a more likely aetiology and must also be suspected in HIV patients presenting with compressive symptoms of the neck, neurological impairment or stroke.
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Affiliation(s)
| | - Cristian Borrazzo
- Department of Public Health and Infectious Disease, Sapienza University of Rome, Roma, Italy
| | - Rita Mele
- Surgical Science Department, La Sapienza University, Roma, Italy
| | - Gabriella d'Ettorre
- Department of Public Health and Infectious Disease, Sapienza University of Rome, Roma, Italy
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20
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Mubder M, Azab M, Jayaraj M, Cross C, Lankarani D, Dhindsa B, Pan JJ, Ohning G. Autoimmune hepatitis in patients with human immunodeficiency virus infection: A systematic review of the published literature. Medicine (Baltimore) 2019; 98:e17094. [PMID: 31517833 PMCID: PMC6750342 DOI: 10.1097/md.0000000000017094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Liver disease in patients with HIV is common and typically has complex and multifactorial presentations that represent a major cause of morbidity and mortality. Autoimmune hepatitis (AIH) is rarely reported in patient with HIV and the disease course and clinical outcomes for treatment have not been well characterized. We are aiming to determine the patient characteristics, disease prevalence, and treatment outcomes from published articles of patients with HIV and AIH. METHOD A systematic search of PubMed, Web of Science, and Google Scholar through February 20, 2019 identified 15 studies that reported the outcomes of AIH in patients with HIV. Because of the small sample sizes and skewed distributions, resampling tests of mean differences using permutation distributions (MAXn = 10,000 permutations) were utilized; analyses were performed using R (v. 3.5.1). Categorical differences were calculated using Fisher exact test for odds ratio = 1 (equal odds), and Cramer V was calculated for effect size; analyses were completed in SPSS (v. 25). RESULTS By reviewing 15 studies reporting a total of 35 patients with AIH and HIV, male patients were found to have significantly higher aspartate transaminase and alanine transaminase levels at time of diagnosis. No other significant findings identified. The CD4 count and viral load did not show significant correlation with AIH diagnosis or its prognosis. All patients but one who presented with severe immune deficiency and responded to highly active anti-retroviral therapy received immunosuppressive treatment without side effects and achieved remission except 2 lost to follow-up and 3 expired. CONCLUSION Although rare, but AIH can develop in patients with HIV and physicians should consider it in the differential diagnosis for HIV patients presented with abnormal liver function tests, especially after excluding hepatitis C virus and drug-induced liver injury.Patients with immune deficiency disorders who present with AIH can be treated safely with steroid either as monotherapy or in combination with another immune suppressant therapy.
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Affiliation(s)
- Mohamad Mubder
- Department of Internal Medicine, University of Nevada, Las Vegas, NV
| | - Mohamed Azab
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Loma Linda University, Loma Linda, CA
| | - Mahendran Jayaraj
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Nevada, Las Vegas, NV
| | | | - Daisy Lankarani
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Nevada, Las Vegas, NV
| | - Banreet Dhindsa
- Department of Internal Medicine, University of Nevada, Las Vegas, NV
| | - Jen-Jung Pan
- Department of Internal medicine, Division of Gastroenterology and Hepatology, University of Arizona-College of Medicine, Phoenix, AZ
| | - Gordon Ohning
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Nevada, Las Vegas, NV
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21
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Silvestri V, D'Ettorre G, Borrazzo C, Mele R. Many Different Patterns under a Common Flag: Aortic Pathology in HIV-A Review of Case Reports in Literature. Ann Vasc Surg 2019; 59:268-284. [PMID: 31051229 DOI: 10.1016/j.avsg.2019.01.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 01/21/2019] [Accepted: 01/30/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Availability of highly active antiretroviral therapy (HAART) for HIV has prolonged life expectancy of patients but has also increased the incidence of non-AIDS comorbid conditions. Among these, there are cardiovascular diseases, and aortic involvement has been described in patients with HIV in the form of aortitis, aneurysms, or dissections. Our study aims to describe aortic pathology occurring in patients with HIV, focusing on clinical and surgical presentation, management, and outcome, through a review of cases published in literature. METHODS MEDLINE (www.ncbi.nlm.nih.gov/pubmed) database was reviewed for "aortitis" OR "aortic aneurysm" OR "aortic dissection" AND HIV. Research was restricted to English language. Only case reports were included. Data on patients' age, sex, traditional risk factors, timing from HIV diagnosis, pharmacological details, coinfection (syphilis, hepatitis C virus [HCV], and hepatitis B virus [HBV]), anatomical localization of lesion, presence of inflammatory involvement, rapid growing or rupture, and surgical treatment and outcomes were collected and summarized in tables. RESULTS Forty articles (51 cases) were included in the study. The mean age of patients was 48.8 ± 8.3 years. Male sex was preponderant (43 cases, 84.3%). Among traditional risk factors, hypertension and smoking were the most frequently reported ones (14 and 13 cases, respectively), followed by vasculopathy involving other arterial districts, dyslipidemia, diabetes, and drug addiction. In 3 cases, HIV was diagnosed in the same time as aortic pathology, whereas in most cases, aortic event occurred after five years from HIV diagnosis. In 30.5% of cases for which data on pharmacologic management were available, no treatment or poor adherence was reported. Coinfection occurred in some cases (syphilis in 6, HCV in 5, and HBV in 3). As for anatomical involvement, isolated thoracic lesions were more frequent (24, 47.1%), followed by abdominal and thoracoabdominal lesions. The etiology ranged from bacterial mycotic aneurysms to tertiary syphilis, postsurgical complications, or atherosclerosis. In 3 cases, HIV vasculitis was directly suggested, and in another 2, no other potential etiology had been diagnosed through cultural tests. Open surgical treatment was carried out in 30 cases (58.8%), and in addition, 10 endovascular (19.6%) and 2 hybrid procedures were described. Inflammatory features occurred in 7 cases, and a rapid evolution of lesions in 6. In 9 cases (17.6%), rupture occurred. Mortality was reported in 8 cases (15.7%). CONCLUSIONS Aortic pathology may occur in patients with HIV. The entanglement of different patterns of pathological involvement of the aortic wall, secondary to immune dysregulation, infectious process, or atherosclerotic damage that may co-occur in one single case, results in a very challenging management of the condition. Because of the increased life expectancy of patients and immigration from regions with both high HIV and coinfection prevalence, the incidence of aortic pathology could increase in the upcoming years, suggesting the urgent need for further studies to optimize management in these very complex cases.
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Affiliation(s)
| | - Gabriella D'Ettorre
- Department of Public Health and Infectious Disease, Sapienza University of Rome, Rome, Italy
| | - Cristian Borrazzo
- Department of Public Health and Infectious Disease, Sapienza University of Rome, Rome, Italy
| | - Rita Mele
- Surgical Science Department La Sapienza University, Roma, Italy
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22
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Shoenfeld Y, Ehrenfeld M, Perry O. The kaleidoscope of autoimmunity – From genes to microbiome. Clin Immunol 2019; 199:1-4. [DOI: 10.1016/j.clim.2018.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Belgaumkar VA, Chavan RB, Suryataley PR, Salunke AS, Patil PP, Borade SM. Systemic lupus erythematosus in HIV: An insight into clinical implications and management. Indian J Sex Transm Dis AIDS 2019; 40:64-66. [PMID: 31143863 PMCID: PMC6532495 DOI: 10.4103/ijstd.ijstd_26_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Although HIV infection can mimic the manifestations of various autoimmune disorders, the coexistence of HIV and systemic lupus erythematosus (SLE) has been rarely reported. The exact impact of HIV on SLE and vice versa is unclear. We report an HIV-seropositive female on highly active antiretroviral therapy presenting with features of SLE. Herein, an attempt has been made to discuss the various complex clinical and therapeutic implications along with the influence on disease course and prognosis.
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Tiewsoh K, Kumar Jindal A, Sharma D, Arora S, Minz RW, Agrawal P, Nada R, Suri D. Spectrum of renal disease in HIV-infected children: report of five cases. Paediatr Int Child Health 2018; 38:271-276. [PMID: 29726752 DOI: 10.1080/20469047.2018.1463126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
There is a paucity of literature on renal diseases associated with HIV infection in Asian countries. Renal disease in HIV-infected children can involve the glomerulus, interstitium, tubules or blood vessels of the kidney. In this case series, five HIV-infected children with various forms of renal disease are reported. The renal pathology included HIV-associated nephropathy, collapsing focal segmental glomerulosclerosis without tubular changes, tubule-interstitial nephritis and minimal change disease (MCD). Case five fulfilled the classification criteria for childhood polyarteritis nodosa (PAN). It is important to screen all HIV-infected children for renal disease to enable detection at an early stage.
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Key Words
- ATN, acute tubular necrosis
- Collapsing focal segmental glomerulosclerosis
- EULAR/PRINTO/PRES, European League Against Rheumatism/Paediatric Rheumatology International Trials Organisation/Paediatric Rheumatology European Society
- HIV-associated nephropathy
- HIVAN, HIV-associated nephropathy
- HVICK, HIV immune complex kidney disease
- NACO, National AIDS Control Organization
- NGAL, neutrophil gelatinase associated lipocalin
- NHL, non-Hodgkin lymphoma
- PAH, pulmonary artery hypertension
- PAN, polyarteritis nodosa
- TIN, tubule-interstitial nephritis
- cART, combination anti-retroviral therapy
- eGFR, estimated glomerular filtration rate
- interstitial nephritis
- minimal change disease
- non-Hodgkin lymphoma
- proteinuria
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Affiliation(s)
- Karalanglin Tiewsoh
- a Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre , PGIMER , Chandigarh , India
| | - Ankur Kumar Jindal
- a Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre , PGIMER , Chandigarh , India
| | - Dhrubajyoti Sharma
- a Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre , PGIMER , Chandigarh , India
| | - Sunil Arora
- b Department of Immunopathology , PGIMER , Chandigarh , India
| | - Ranjana W Minz
- b Department of Immunopathology , PGIMER , Chandigarh , India
| | - Parimal Agrawal
- c Department of Histopathology , PGIMER , Chandigarh , India
| | - Ritambhra Nada
- c Department of Histopathology , PGIMER , Chandigarh , India
| | - Deepti Suri
- a Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre , PGIMER , Chandigarh , India
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Genovese G, Nazzaro G, Coggi A, Gianotti R, Ramoni S, Cusini M. Secondary syphilis masquerading as lupus vulgaris in an HIV-infected patient: A diagnosis suggested by histology. Int J STD AIDS 2018; 29:1454-1456. [PMID: 30170530 DOI: 10.1177/0956462418795590] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We report a case of secondary syphilis mimicking lupus vulgaris in an HIV-infected patient. A 21-year-old Brazilian man presented with a two-month history of asymptomatic cutaneous lesions accompanied by fever and fatigue. Dermatological evaluation revealed an erythematous, crusted, large plaque on the neck with the 'apple jelly' sign on diascopy and two smaller scaly elements on the trunk and left palm. Bacteriological examinations for bacteria and mycobacteria gave negative results. Histology revealed psoriasiform epidermal hyperplasia and dermal lymphoplasmacytic infiltrate. Serology for syphilis was positive, and immunohistochemistry confirmed the presence of Treponema pallidum in lesional skin. A diagnosis of secondary syphilis was made, and the patient was successfully treated with benzathine penicillin G. Cutaneous manifestations of secondary syphilis are protean and skin tuberculosis may be considered in the differential diagnosis, especially in HIV-infected patients. In the current case, clinical examination, and particularly, 'apple jelly' sign positivity, was suggestive of lupus vulgaris, but only typical histopathology and immunohistochemistry led to the correct diagnosis of secondary syphilis.
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Affiliation(s)
- Giovanni Genovese
- Dermatology Unit, Department of Physiopathology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gianluca Nazzaro
- Dermatology Unit, Department of Physiopathology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Antonella Coggi
- Dermatology Unit, Department of Physiopathology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Raffaele Gianotti
- Dermatology Unit, Department of Physiopathology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefano Ramoni
- Dermatology Unit, Department of Physiopathology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marco Cusini
- Dermatology Unit, Department of Physiopathology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Simmons GS, Habarugira G. The Origins of Gibbon Ape Leukaemia Virus. Primates 2018. [DOI: 10.5772/intechopen.71694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Torquato BGS, Oliveira MS, Juliano GR, Aguiar LS, Juliano GR, Silveira LMD, Espíndula AP, Oliveira LF, Cavellani CL, Oliveira FAD, Teixeira VDPA, Ferraz MLF. Analysis of the collagen fibers on autopsied patients’ uterus with the Acquired Immunodeficiency Syndrome. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2018. [DOI: 10.1590/1806-93042018000100010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abstract Objectives: to compare the percentage of collagen fibers in the autopsied women’s uterine body and cervix with and without the Acquired Immunodeficiency Syndrome (Aids). Methods: 30 autopsied women’s medical files were selected from 1988 to 2013. 30 fragments of the uterine body and 30 cervix were collected and then divided into two groups, 15 with Aids and 15 without, The quantification of the collagen fibers of the uterine body and cervix was performed on slides stained with picrosirius, using the KS-300® system. Results: the percentage of collagen fibers was lower for cervix (U=336544; p=0.001) and higher for the uterine body (U=308726,5; p=0.004) in the retroviral group when compared to the group without the disease. The percentage was higher for cervix than the uterine body in the group with Aids (t=0,4793; p=0.0031). the same result was found in the group without Aids (t=2,397; p=0.0637). Conclusions: the increase in the percentage of collagen fibers in the uterine body of women with Aids’ indicates an immune response for viral infection and reveals a failure in keeping the infection restricted to the cervix. The interpretation of the histochemical and morphometric parameters can be useful in the diagnosis associated to HIV infection, contributing for clinical improvement and life expectancy.
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Kaspar MB, Sterling RK. Mechanisms of liver disease in patients infected with HIV. BMJ Open Gastroenterol 2017; 4:e000166. [PMID: 29119002 PMCID: PMC5663263 DOI: 10.1136/bmjgast-2017-000166] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 08/20/2017] [Accepted: 09/03/2017] [Indexed: 12/20/2022] Open
Abstract
Objective To describe the various mechanisms of liver disease in patients with HIV infection, and to link these mechanisms to disease states which may utilise them. Background Non-AIDS causes of morbidity and mortality are becoming increasingly common in patients chronically infected with HIV. In particular, liver-related diseases have risen to become one of the leading causes of non-AIDS-related death. A thorough understanding of the mechanisms driving the development of liver disease in these patients is essential when evaluating and caring for these patients. Methods The literature regarding mechanisms of liver disease by which different disease entities may cause hepatic injury and fibrosis was reviewed and synthesised. Results A number of discrete mechanisms of injury were identified, to include: oxidative stress, mitochondrial injury, lipotoxicity, immune-mediated injury, cytotoxicity, toxic metabolite accumulation, gut microbial translocation, systemic inflammation, senescence and nodular regenerative hyperplasia. Disease states may use any number of these mechanisms to exert their effect on the liver. Conclusions The mechanisms by which liver injury may occur in patients with HIV infection are numerous. Most disease states use multiple mechanisms to cause hepatic injury and fibrosis.
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Affiliation(s)
- Matthew B Kaspar
- Department of Internal Medicine, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA
| | - Richard K Sterling
- Department of Internal Medicine, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA.,Section of Hepatology, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA.,Division of Infectious Disease, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA
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Abstract
Human immunodeficiency virus (HIV) infection continues to be a leading cause of morbidity and mortality. HIV-infected individuals are now surviving for a relatively longer period and this is because of easy accessibility to antiretroviral therapy these days. As a result, chronic disease-related complications are now being recognized more often. Kidney disease in HIV-infected children can vary from glomerular to tubular-interstitial involvement. We searched the database to identify various kidney diseases seen in HIV-infected children. We describe the epidemiology, pathogenesis, pathology, clinical and laboratory manifestations, management and outcome of commonly seen kidney disease in HIV-infected children. We also provide a brief overview of toxicity of antiretroviral drugs seen in HIV-infected children. Kidney involvement in HIV-infected children may arise because of HIV infection per se, opportunistic infections, immune mediated injury and drug toxicity. HIV-associated nephropathy is perhaps the most common and most severe form of kidney disease. Proteinuria may be a cost-effective screening test in the long-term management of HIV-infected children, however, there are no definite recommendations for the same. Other important renal diseases are HIV immune complex kidney disease, thrombotic microangiopathy, interstitial nephritis and vasculitis.
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Affiliation(s)
- Ankur Kumar Jindal
- a Department of Paediatrics, Allergy Immunology and Nephrology Unit , Advanced Paediatrics Centre, Postgraduate Institute of Medical Education and Research , Chandigarh , India
| | - Karalanglin Tiewsoh
- a Department of Paediatrics, Allergy Immunology and Nephrology Unit , Advanced Paediatrics Centre, Postgraduate Institute of Medical Education and Research , Chandigarh , India
| | - Rakesh Kumar Pilania
- a Department of Paediatrics, Allergy Immunology and Nephrology Unit , Advanced Paediatrics Centre, Postgraduate Institute of Medical Education and Research , Chandigarh , India
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Sharma A, Hudson M, Watters K, Billick R, Fallavolita S, Netchiporouk E. Rapidly progressive melanoma differentiation-associated protein 5-positive amyopathic dermatomyositis in an HIV-positive patient. JAAD Case Rep 2017; 3:158-161. [PMID: 28374003 PMCID: PMC5367795 DOI: 10.1016/j.jdcr.2017.01.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Ashutosh Sharma
- Faculty of Medicine, McGill University, Montréal, Quebec, Canada
| | - Marie Hudson
- Department of Rheumatology, Jewish General Hospital, Montréal, Quebec, Canada
| | - Kevin Watters
- Department of Pathology, McGill University Health Centre, Montréal, Quebec, Canada
| | - Robin Billick
- Department of Dermatology, Jewish General Hospital, Montréal, Quebec, Canada
| | - Sabrina Fallavolita
- Department of Rheumatology, Jewish General Hospital, Montréal, Quebec, Canada
| | - Elena Netchiporouk
- Department of Dermatology, Jewish General Hospital, Montréal, Quebec, Canada
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