Diffuse connective tissue disorders in HIV-infected patients

Abstract

Background: Human immunodeficiency virus (HIV) infection has been associated with various autoimmune disorders.

Aim: To review the spectrum of diffuse connective tissue disorders (dCTD) in HIV-infected patients, in the context of highly active anti-retroviral therapy.

Methods: Electronic search of the literature was performed using the terms HIV, AIDS, autoimmune, rheumatic/rheumatological, immune reconstitution inflammatory syndrome, Systemic Lupus Erythematosus, Diffuse Infiltrative Lymphocytosis Syndrome, Sjogren's syndrome, vasculitis, Behçet's disease, cryoglobulins, Henoch-Schönlein purpura, and antiphospholipid syndrome.

Results: We reviewed the clinical manifestations, natural history and treatment of dCTDs, since the implementation of Highly Active Anti-Retroviral Therapy (HAART), and the emergence of new pathogenic mechanisms, such as the immune reconstitution inflammatory syndrome.

Conclusions: Caution in differentiating clinical and laboratory findings of dCTDs from non-specific manifestations of acute and chronic HIV infection is warranted due to the common presentation. Patients with chronic infection and access to HAART have a normal life expectancy and dCTDs, although rare, must be correctly addressed. HAART alone or combined with immunosuppressive therapy result in favourable outcomes.

Keywords: AIDS; Antiphospholipid Syndrome; Behçet’s disease; Cryoglobulinemic Vasculitis; DILS; Diffuse Infiltrative Lymphocytosis Syndrome; HAART; HIV; Henoch-Schönlein purpura; Highly Active Anti-retroviral Therapy; Lupus Erythematosus; Sjogren’s syndrome; connective tissue disorders; cryoglobulins; immune reconstitution inflammatory syndrome; immunosuppressant drugs; rheumatic; sicca; vasculitis.