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Iordache L, Launay O, Bouchaud O, Jeantils V, Goujard C, Boue F, Cacoub P, Hanslik T, Mahr A, Lambotte O, Fain O. Autoimmune diseases in HIV-infected patients: 52 cases and literature review. Autoimmun Rev 2014; 13:850-7. [PMID: 24747058 DOI: 10.1016/j.autrev.2014.04.005] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 04/04/2014] [Indexed: 12/12/2022]
Abstract
OBJECTIVES 1) To describe autoimmune diseases (AD) in HIV-infected people; and 2) to perform a literature review concerning this issue. DESIGN 52 HIV-infected patients that presented an AD in 14 medical departments in Paris and Ile-de-France area were retrospectively included in this study. RESULTS The ADs were vasculitis (11), immune cytopenias (8), rheumatic diseases (8), lupus (7), sarcoidosis (7), thyroid diseases (6), hepatic diseases (5), and antiphospholipid syndrome (4). Four patients presented 2 ADs. In 5 patients the AD preceded HIV infection, in 14 HIV infection was diagnosed at the same time as the AD and 34 were HIV-infected when they developed an AD. 40 ADs (80%) occurred in patients with a CD4 T lymphocyte count of more than 200/mm(3). Cases of autoimmune hemolytic anemia occurred only in patients severely immunodepressed. In five patients (a vasculitis case, a sarcoidosis case, three thyroid disease cases) the AD presented as a form of immune restoration inflammatory syndrome (IRIS). Some ADs allowed HIV-infection diagnosis at a stage of moderate immune deficiency (vasculitis, antiphospholipid syndrome, immune thrombocytopenia). 37 patients received immunosuppressant treatments with good tolerance. These results confirm in a large series of patients previous data concerning autoimmune diseases occurrence in HIV-infected people. CONCLUSION In the HAART era, when HIV-infected people are treated more and more early, autoimmune diseases can occur, mainly at the phase of immunological recovery. HIV infection should not limit immunosuppressant treatment use.
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Affiliation(s)
- Laura Iordache
- Internal Medicine Department, Jean Verdier Hospital, Avenue du 14 Juillet, 93140 Bondy, France.
| | - Odile Launay
- Clinical Investigation Centre, Cochin Hospital, 27 rue du Fbg St.-Jacques, 75014 Paris, France
| | - Olivier Bouchaud
- Infectious Diseases Department, Avicenne Hospital, 125 rue de Stalingrad, 93009 Bobigny, France
| | - Vincent Jeantils
- Infectious Diseases Department, Jean Verdier Hospital, Avenue du 14 Juillet, 93140 Bondy, France
| | - Cécile Goujard
- Internal Medicine Department, Kremlin Bicetre Hospital, 78 rue du Général Leclerc, 94270 Le Kremlin-Bicetre, France
| | - Francois Boue
- Internal Medicine Department, Antoine Béclère Hospital, 157 rue de la Porte de Trivaux, 92140 Clamart, France
| | - Patrice Cacoub
- Internal Medicine and Clinical Immunology Department, Pitié-Salpétrière Hospital, 47-83 bd de l'Hopital, 75013 Paris, France; Hospital-University Department I2B, Sorbonne Universités, UPMC Paris 6 University, UMR 7211, F-75005, Paris, France; INSERM, UMR S959, F-75013, Paris, France; CNRS, UMR 7211, F-75005, Paris, France
| | - Thomas Hanslik
- Internal Medicine Department, Ambroise Paré Hospital, 9 Avenue Charles-de-Gaulle, 92100 Boulogne Billancourt, France
| | - Alfred Mahr
- Internal Medicine Department, St. Louis Hospital, 1 Avenue Claude-Vellefaux, 75010 Paris, France
| | - Olivier Lambotte
- Internal Medicine Department, Kremlin Bicetre Hospital, 78 rue du Général Leclerc, 94270 Le Kremlin-Bicetre, France
| | - Olivier Fain
- Internal Medicine Department, Jean Verdier Hospital, Avenue du 14 Juillet, 93140 Bondy, France
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Abstract
Vasculitis may be associated with infection, immunization or anti-microbial drugs. Infections are responsible for a number of different types of vasculitis. Conversely, patients with vasculitis may develop infections, which sometimes mimic relapse. The aim of this review is to summarize the various aspects of the inter-relationship between vasculitis and infection, and the physiopathological mechanisms involved, in light of our current knowledge from animal models. Currently, a causal relationship between infection and vasculitis has only been established in a few instances and many mechanisms remain hypothetical. This inter-relationship is further assessed from the point of view of clinical presentation and therapeutic options, based on case reports and prospective observational data.
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