aidsВИЧ-инфекция и иммуносупрессииHIV Infection and Immunosuppressive Disorders2077-9828Baltic Medical Education Center10.22328/2077-9828-2025-17-1-7-18aids-979Research ArticleАНАЛИТИЧЕСКИЕ ОБЗОРЫANALYTICAL REVIEWSВИЧ-инфекция и аутоиммунные болезни: современное состояние проблемыHIV-infection and rheumatic diseases: the current state of the problemhttps://orcid.org/0000-0002-0928-3911ГридневаГ. И.GridnevaG. I.

Гриднева Галина Игоревна — кандидат медицинских наук, научный сотрудник лаборатории коморбидных инфекций и вакцинопрофилактики

115522, Москва, Каширское шоссе, д. 34а

gigridneva@mail.ruhttps://orcid.org/0000-0001-7091-2054БеловБ. С.BelovB. S.

Белов Борис Сергеевич — доктор медицинских наук, руководитель лаборатории коморбидных инфекций и вакцинопрофилактики

115522, Москва, Каширское шоссе, д. 34а

belovbor@yandex.ruhttps://orcid.org/0000-0002-1833-5357АроноваЕ. С.AronovaE. S.

Аронова Евгения Сергеевна — кандидат медицинских наук, научный сотрудник лаборатории коморбидных инфекций и вакцинопрофилактики

115522, Москва, Каширское шоссе, д. 34а

Научно-исследовательский институт ревматологии имени В. А. НасоновойРоссияV. A. Nasonova Rheumatology Research InstituteRussian Federation202511042025171718Copyright © Гриднева Г.И., Белов Б.С., Аронова Е.С., 20252025Гриднева Г.И., Белов Б.С., Аронова Е.С.Gridneva G.I., Belov B.S., Aronova E.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://hiv.bmoc-spb.ru/jour/article/view/979

Проблема аутоиммунных заболеваний у ВИЧ-инфицированных пациентов является междисциплинарной, при решении ее на первый план зачастую выходят вопросы дифференциальной диагностики. Взаимодействие между ВИЧ и иммунной системой человека характеризуется дисбалансом в популяциях лимфоцитов с избирательным истощением некоторых подтипов CD4-лимфоцитов и сохранением иммунной активации. Этот дисбаланс, сохраняющийся в течение длительного периода времени, провоцирует раннее появление фенотипа иммуностарения, который связан с нарастанием частоты развития аутоиммунных реакций. Увеличивается частота развития ревматических заболеваний (РЗ) у людей, живущих с ВИЧ (ЛЖВ), при этом своевременная диагностика, обоснование, выбор и раннее начало комплексной терапии коморбидной патологии являются крайне актуальными задачами. Частота возникновения аутоиммунных заболеваний у ЛЖВ различна: системной красной волчанки — 6,25%, реактивного артрита (часто HLA-B27-ассоциированного) — 2,67%, псориатического артрита — 1–3%, ревматоидного артрита — 0,29%, синдрома Шёгрена — 0,03%, системных васкулитов — 1%, возможно развитие нескольких иммунопатологических процессов. Нередки случаи обнаружения ряда аутоантител без развития клинической картины аутоиммунного заболевания. Необходимо учитывать особенности назначения антиревматической терапии в условиях обязательной и непрерывной антиретровирусной терапии (АРТ), постоянного мониторинга количества CD4-лимфоцитов и РНК ВИЧ в крови, риска развития синдрома восстановления иммунной системы (СВИС) и реактивации оппортунистических инфекций при выраженной иммуносупрессии. Ведение пациентов со сложной коморбидностью — ВИЧ-инфекцией и ревматическими болезнями, должно осуществляться в составе междисциплинарного коллектива при обязательном участии врача-инфекциониста, постоянном мониторинге количества CD4-лимфоцитов и уровня вирусной нагрузки ВИЧ в крови.

The problem of autoimmune diseases in HIV-infected patients is interdisciplinary, and differential diagnosis issues often come to the fore. The interaction between HIV and the human immune system is characterized by an imbalance in lymphocyte populations with selective depletion of certain subtypes of CD4 lymphocytes and preservation of immune activation. This imbalance, which persists for a long time, provokes the early appearance of the immune aging phenotype, which is associated with an increase in the frequency of autoimmune reactions. The incidence of rheumatic diseases in people living with HIV (PLHIV) is increasing, while timely diagnosis, justification, selection and early initiation of complex therapy for comorbid pathology are extremely urgent tasks. The incidence of autoimmune diseases in PLHIV varies: systemic lupus erythematosus — 6.25%, reactive arthritis (often HLA-B27-associated) — 2.67%, psoriatic arthritis — 1–3%, rheumatoid arthritis — 0.29%, Sjogren’s syndrome — 0.03%, systemic vasculitis — 1%, also several pathological processes can develop simultaneously. It is not uncommon to detect a number of autoantibodies without developing an autoimmune disease symptoms. It is necessary to take into account the features of prescribing antirheumatic therapy in the context of mandatory and continuous antiretroviral therapy (ART), constant monitoring of the number of CD4 lymphocytes and HIV RNA in the blood, the risk of developing immune reconstitution inflammatory syndrome and reactivation of opportunistic infections with severe immunosuppression. Management of patients with complex comorbidity, such as HIV infection and rheumatic diseases, should be carried out as part of an interdisciplinary team with the mandatory participation of an infectious disease specialist, constant monitoring of the number of CD4 lymphocytes and the level of HIV viral load in the blood.

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The authors declare that there are no conflicts of interest present.