ВИЧ-инфекция и аутоиммунные болезни: современное состояние проблемы

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.

1. ВИЧ-инфекция у взрослых. Клинические рекомендации 2024. https://cr.minzdrav.gov.ru/schema/79_2.

2. ВИЧ-инфекция в Российской Федерации на 30 июня 2023 г. Специализированный научно-исследовательский отдел по профилактике и борьбе со СПИДом ФБУН Центрального НИИ эпидемиологии Роспотребнадзора. . https://files.antispidnn.ru/uploads/docs/spec/vich2023.pdf.

3. Steve R.J., Alex D., Yesudhason B.L. et al. Autoantibodies Among HIV-1 Infected Individuals and the Effect of Anti-Retroviral Therapy (ART) on It // Current HIV research. 2021. Vol. 19, No. 3. Р. 277–285. https://doi.org/10.2174/1570162X19666210217120337.

4. Zandman-Goddard G., Shoenfeld Y. HIV and autoimmunity // Autoimmunity reviews. 2002. Vol. 1, No. 6. P. 329–337. https://doi.org/10.1016/s1568-9972(02)00086-1.

5. Fox C., Walker-Bone K. Evolving spectrum of HIV-associated rheumatic syndromes. Best practice research // Clinical rheumatology. 2015. Vol. 29, No. 2. P. 244–258. https://doi.org/10.1016/j.berh.2015.04.019.

6. Ramos-Ruperto L., Busca C., Díez-Vidal A. et al. Prevalence and Temporal Trends of Autoimmune Diseases in People Living with HIV // AIDS Res. Hum. Retroviruses. 2023 Mar; Vol. 39, No. 3. Р. 130–135. doi: 10.1089/AID.2022.0090.

7. Ramos-Ruperto L. et al. Autoimmunity and HIV infection. Chapter 7 // Translational Autoimmunity. Vol. 3. Р. 141. https://doi.org/10.1016/B978-0-323-85415-3.00015-5.

8. Evans R., Gueret-Wardle A., Edwards S., Salama A. ANCA-associated vasculitis and pauci-immune glomerulonephritis in HIV disease // BMJ case reports 2014. P. 1–3. Published online 1 April 2014. https://doi.org/10.1136/bcr-2013-202423.

9. Mirsaeidi M., Syed F., Jaffe E.S. Antineutrophil Cytoplasmic Autoantibody Associated Systemic Vasculitis Is Associated with Epstein–Barr virus in the Setting of HIV Infection // Infectious diseases in clinical practice (Baltimore, Md.). 2013. Vol. 21, No. 1. P. 50–53. https://doi.org/10.1097/IPC.0b013e3182601ea1.

10. Savige J.A., Chang L., Horn S., Crowe S.M. Anti-nuclear, anti-neutrophil cytoplasmic and anti-glomerular basement membrane antibodies in HIV-infected individuals // Autoimmunity. 1994. Vol. 18, No. 3. P. 205–211. https://doi.org/10.3109/08916939409007997

11. Mohapatra P. R., Khanduri S., Dutt N., Sharma P., Janmeja A. K. Diagnostic dilemma of antineutrophil cytoplasmic antibody seropositivity in human immunodeficiency virus infection // The Indian journal of chest diseases allied sciences. 2011. Vol. 53, No. 1. P. 55–57.

12. Gherardi R., Belec L., Mhiri C. et al. The spectrum of vasculitis in human immunodeficiency virus-infected patients. A clinicopathologic evaluation // Arthritis and rheumatism. 1993. Vol. 36, No. 8. P. 1164–1174. https://doi.org/10.1002/art.1780360818.

13. Bottlaender L., Sève P., Cotte L., Gerfaud-Valentin M., Jamilloux Y. Successful treatment with anakinra of an HIV-associated immune reconstitution inflammatory syndrome mimicking adult-onset Still’s disease // Rheumatology (Oxford, England). 2019. Vol. 58, No. 2. P. 363–365. https://doi.org/10.1093/rheumatology/key291.

14. Российские клинические рекомендации. Ревматология / под ред. Е. Л. Насонова. М.: ГЭОТАР-Медиа, 2017. С. 113

15. Akram B., Khan M., Humphrey M.B. HIV-Associated Rheumatic Diseases: A Narrative Review // Journal of clinical rheumatology: practical reports on rheumatic musculoskeletal diseases. 2024. Vol. 30, No. 2. P. e42–e45. https://doi.org/10.1097/RHU.0000000000002028.

16. Lebrun D., Hentzien M., Cuzin L. et al.; the Dat’AIDS study group. Epidemiology of autoimmune and inflammatory diseases in a French nationwide HIV cohort // AIDS. 2017. Sep 24; Vol. 31, No. 15. Р. 2159–2166. doi: 10.1097/QAD.0000000000001603.

17. Kawakita C., Kinomura M., Otaka N. et al. HIV-associated Immune Complex Kidney Disease with C3-dominant Deposition Induced by HIV Infection after Treatment of IgA Nephropathy // Internal medicine (Tokyo, Japan). 2019. Vol. 58, No. 20. P. 3001–3007. https://doi.org/10.2169/internalmedicine.2439-18.

18. Naovarat B.S., Reveille J.D., Salazar G.A., William F.M., Nguyen B.Y. Systemic lupus erythematosus in the setting of HIV-1 infection: a longitudinal analysis // Clinical rheumatology. 2020. Vol. 39, No. 2. P. 413–418. https://doi.org/10.1007/s10067-019-04867-w.

19. Torgashina A.V., Solovyev S.K. Specific features of regulatory T cells in patients with systemic lupus erythematosus // Modern Rheumatology Journal. 2018. Vol. 12, No. 4. P. 9–15. doi: 10.14412/1996-7012-2018-4-9-15.

20. Liao H.Y., Tao C.M., Su J. Concomitant systemic lupus erythematosus and HIV infection: A rare case report and literature review // Medicine. 2017. Vol. 96, No. 51. P. e9337. https://doi.org/10.1097/MD.0000000000009337.

21. O’Kelly B., McNally C., McConkey S., Durcan L. HIV and systemic lupus erythematosus: where immunodeficiency meets autoimmunity // Lupus. 2020. Vol. 29, No. 9. P. 1130–1132. https://doi.org/10.1177/0961203320934851.

22. Российские клинические рекомендации. Ревматология / под ред. Е. Л. Насонова. М.: ГЭОТАР-Медиа, 2020. С. 17

23. Smolen J.S., Aletaha D., McInnes I.B. Rheumatoid arthritis // Lancet (London, England). 2016. Vol. 388, No. 10055. P. 2023–2038. https://doi.org/10.1016/S0140-6736(16)30173-8.

24. Reveille J.D., Williams F.M. Infection and musculoskeletal conditions: Rheumatologic complications of HIV infection. Best practice and research // Clinical rheumatology. 2006. Vol. 20, No. 6. P. 1159–1179. https://doi.org/10.1016/j.berh.2006.08.015.

25. Буханова Д.В., Белов Б.С. Поражение суставов при ВИЧ-инфекции // Медицинский cовет. 2018. № 9. C. 82–87

26. Hanberg J.S., Hsieh E., Akgün K.M., Weinstein E., Fraenkel L., Justice A.C., VACS Project Team. Incident Rheumatoid Arthritis in HIV Infection: Epidemiology and Treatment // Arthritis rheumatology (Hoboken N.J.). 2021. Vol. 73, No. 12. P. 2189–2199. https://doi.org/10.1002/art.41802.

27. Cunha B.M., Mota L.M., Pileggi G.S., Safe I.P., Lacerda M.V. HIV/AIDS and rheumatoid arthritis // Autoimmunity reviews. 2015. Vol. 14, No. 5. P. 396–400. https://doi.org/10.1016/j.autrev.2015.01.001.

28. Azeroual A., Harmouche H., Benjilali L. et al. Rheumatoid arthritis associated to HIV infection // European journal of internal medicine. 2008. Vol. 19, No. 6. P. e34–e35. https://doi.org/10.1016/j.ejim.2007.09.020.

29. Mariette X., Criswell L.A. Primary Sjögren’s Syndrome // The New England journal of medicine. 2018. Vol. 378, No. 10. P. 931–939. https://doi.org/10.1056/NEJMcp1702514.

30. Ghrenassia E., Martis N., Boyer J. et al. The diffuse infiltrative lymphocytosis syndrome (DILS). A comprehensive review // Journal of autoimmunity. 2015. No. 59, P. 19–25. https://doi.org/10.1016/j.jaut.2015.01.010.

31. Yang J.J., Tsai M.S., Sun H.Y. et al. Autoimmune diseases-related arthritis in HIV-infected patients in the era of highly active antiretroviral therapy // Journal of microbiology, immunology, and infection=Wei mian yu gan ran za zhi. 2015. Vol. 48, No. 2. P. 130–136. https://doi.org/10.1016/j.jmii.2013.08.002.

32. Каневская М.З. Ревматологические синдромы при ВИЧ-инфекции // Клиническая медицина. 2014. T. 92, № 12. C. 12–19.

33. McArthur C.P., Africa C.W., Castellani W.J. et al. Salivary gland disease in HIV/AIDS and primary Sjögren’s syndrome: analysis of collagen I distribution and histopathology in American and African patients // Journal of oral pathology medicine: official publication of the International Association of Oral Pathologists and the American Academy of Oral Pathology. 2003. Vol. 32, No. 9. P. 544–551. https://doi.org/10.1034/j.1600-0714.2003.00159.x.

34. Saigal R., Chakraborty A., Yadav R.N., Goyal L.K. Rheumatological Manifestations in HIV-Positive Patients: A Single-Center Study // Advances in therapy. 2020. Vol. 37, No. 10. P. 4336–4345. https://doi.org/10.1007/s12325-020-01470-3.

35. Kordossis T., Paikos S., Aroni K. et al. Prevalence of Sjögren’s-like syndrome in a cohort of HIV-1-positive patients: descriptive pathology and immunopathology // British journal of rheumatology. 1998. Vol. 37, No. 6. P. 691–695. https://doi.org/10.1093/rheumatology/37.6.691

36. Kuvardin E.S., Grigor’yeva I.N., Bekhtereva I.A., Maslyansky A.L., Krivolapov Yu.A., Belyakova E.A. Cellular composition of the minor salivary gland inflammatory infiltrates as an additional diagnostic criterion for primary Sjogren’s syndrome // Rheumatology Science and Practice. 2021. Vol. 59, No. 4. P. 434–441 (In Russ.)]. https://doi.org/10.47360/1995-4484-2021-434-441.

37. Российские клинические рекомендации. Ревматология / под ред. Е. Л. Насонова. М.: ГЭОТАР-Медиа, 2020. 182 с.

38. Vega L.E., Espinoza L.R. Vasculitides in HIV Infection // Current rheumatology reports. 2020. Vol. 22, No. 10. P. 60. https://doi.org/10.1007/s11926-020-00945-0.

39. Zhang X., Li H., Li T., Zhang F., Han Y. Distinctive rheumatic manifestations in 98 patients with human immunodeficiency virus infection in China // The Journal of rheumatology. 2007. Vol. 34, No. 8. P. 1760–1764.

40. Vornicu A., Obrișcă B., Sorohan B., Berechet A., Ismail G. ANCA-associated vasculitis in a HIV-infected patient:a case-based review // BMC nephrology. 2023. Vol. 24, No. 1. P. 210. https://doi.org/10.1186/s12882-023-03244-9.

41. De Paoli M.C., Moretti D., Scolari Pasinato C.M., Buncuga M.G. Púrpura de Schönlein-Henoch en adulto HIV positivo adicto a cocaína y ANCAp positivo . Spanish Medicina. 2016. Vol. 76, No. 4. P. 245–248.

42. Monteiro E.J., Caron D., Balda C.A. et al. Anti-glomerular basement membrane glomerulonephritis in an HIV positive patient: case report // The Brazilian journal of infectious diseases: an official publication of the Brazilian Society of Infectious Diseases. 2006. Vol. 10, No. 1. P. 55–58. https://doi.org/10.1590/s1413-86702006000100011.

43. Maharaj A.B. Rheumatoid arthritis and HIV-associated arthritis: Two sides of the same coin or different coins. Best practice research // Clinical rheumatology. 2022. Vol. 36, No. 1. P. 101739. https://doi.org/10.1016/j.berh.2021.101739.

44. Mody G.M., Parke F.A., Reveille, J.D. Articular manifestations of human immunodeficiency virus infection // Best practice and research // Clinical rheumatology. 2003. Vol. 17, No. 2. P. 265–287. https://doi.org/10.1016/s1521-6942(03)00003-2.

45. Lawson E., Walker-Bone K. The changing spectrum of rheumatic disease in HIV infection // British medical bulletin. 2012. Vol. 103, No. 1. P. 203–221. https://doi.org/10.1093/bmb/lds022.

46. Круглова Л.С., Переверзина Н.О. Риски инфекционных заболеваний у пациентов с псориазом кожи, принимающих генно-инженерные препараты: данные собственного исследования // Эффективная фармакотерапия. 2024. Т. 20, No. 1. С. 6–16. doi: 10.33978/2307-3586-2024-20-1-6-16.

47. Ceccarelli M., Venanzi Rullo E., Vaccaro M. et al. HIV-associated psoriasis: Epidemiology, pathogenesis, and management // Dermatologic therapy. 2019. Vol. 32, No. 2. P. e12806. https://doi.org/10.1111/dth.12806.

48. Fink D.L., Hedley L., Miller R.F. Systematic review of the efficacy and safety of biological therapy for inflammatory conditions in HIV-infected individuals // International journal of STD AIDS. 2017. Vol. 28, No. 2. P. 110–119. https://doi.org/10.1177/0956462416675109.

49. Nakamura M., Abrouk M., Farahnik B., Zhu T. H., Bhutani T. Psoriasis treatment in HIV-positive patients: a systematic review of systemic immunosuppressive therapies // Cutis. 2018. Vol. 101, No. 1. P. 38–56.

50. Alpalhão M., Borges-Costa J., Filipe P. Psoriasis in HIV infection: an update // International journal of STD AIDS. 2019. Vol. 30, No. 6. P. 596– 604. https://doi.org/10.1177/0956462419827673.

51. Гриднева Г.И., Белов Б.С. Актуальные вопросы ведения пациентов с ВИЧ-инфекцией и ревматическими заболеваниями // Современная ревматология. 2021. Т. 15, № 6. C. 7–12. https://doi.org/10.14412/1996-7012-2021-6-7-12.

52. Елисеева М.Е., Елисеев М.С. Значение гиперурикемии в развитии заболеваний человека и методы ее коррекции // Доктор. Ру. 2019. Т. 2, № 157. С. 47–54. doi: 10.31550/1727-2378-2019-157-2-47-54.

53. Creighton S., Miller R., Edwards S., Copas A., French P. Is ritonavir boosting associated with gout? // International journal of STD AIDS. 2005. Vol. 16, No. 5. P. 362–364. https://doi.org/10.1258/0956462053888907.

54. Nicholson P., Saunsbury E., D’Angelo S., Churchill D., Walker-Bone K. Prevalence of and risk factors for gout in HIV-positive adults: A casecontrol study // International journal of STD AIDS. 2019. Vol. 30, No. 3. P. 249–255. https://doi.org/10.1177/0956462418799803.

55. Afzal W., Wali O.M., Cervellione K.L., Singh B.B., Bagheri F. Coexistent Pseudogout and Mycobacterium avium-intracellulare Septic Arthritis in a Patient with HIV and ESRD // Case reports in rheumatology. 2016. 5495928. https://doi.org/10.1155/2016/5495928.

56. Hanberg J.S., Akgün K.M., Hsieh E., Fraenkel L., Justice A.C. Incidence and Presentation of Sarcoidosis With and Without HIV Infection // Open forum infectious diseases. 2020. Vol. 7, No. 10. ofaa441. https://doi.org/10.1093/ofid/ofaa441.

57. Foulon G., Wislez M., Naccache J. M. et al. Sarcoidosis in HIV-infected patients in the era of highly active antiretroviral therapy // Clinical infectious diseases: an official publication of the Infectious Diseases Society of America. 2004. Vol. 38, No. 3. P. 418–425. https://doi.org/10.1086/381094.

58. Trevenzoli M., Cattelan A.M., Marino F., Marchioro U., Cadrobbi P. Sarcoidosis and HIV infection: a case report and a review of the literature // Postgraduate medical journal. 2003. Vol. 79, No. 935. P. 535–538. https://doi.org/10.1136/pmj.79.935.535.

59. Ibrahim I.A., Estaitieh O.M., Alrabee H.A., Alzahrani M. Sarcoidosis and HIV infection in a native Saudi man // BMJ case reports. 2018. bcr2018224386. https://doi.org/10.1136/bcr-2018-224386.

60. Adizie T., Moots R.J., Hodkinson B., French N., Adebajo A.O. Inflammatory arthritis in HIV positive patients: A practical guide // BMC infectious diseases. 2016. No. 16. Р. 100. https://doi.org/10.1186/s12879-016-1389-2.

61. Packham J., Arkell P., Sheeran T., Brownfield A., Cadwgan A., Ryan, S. Patient experiences, attitudes and expectations towards receiving information about anti-TNF medication: a quantitative study // Clinical rheumatology. 2017. Vol. 36, No. 11. P. 2595–2600. https://doi.org/10.1007/s10067-017-3642-5.

62. Fink D.L., Hedley L., Miller R.F. Systematic review of the efficacy and safety of biological therapy for inflammatory conditions in HIV-infected individuals // International journal of STD AIDS. 2017. Vol. 28, No. 2. P. 110–119. https://doi.org/10.1177/0956462416675109.

63. Pangilinan M. C. G., Sermswan P., Asawanonda P. Use of Anti-IL-17 Monoclonal Antibodies in HIV Patients with Erythrodermic Psoriasis // Case reports in dermatology. 2020. Vol. 12, No. 2. P. 132–137. https://doi.org/10.1159/000508781.

64. Di Lernia V., Casanova D. M., Garlassi E. Secukinumab in an HIV-positive patient with psoriasis // Journal der Deutschen Dermatologischen Gesellschaft=Journal of the German Society of Dermatology: JDDG. 2019. Vol. 17, No. 6. P. 646–648. https://doi.org/10.1111/ddg.13851.

65. Bartos G., Cline A., Beroukhim K., Burrall B. A., Feldman S. R. Current biological therapies for use in HIV-positive patients with psoriasis: case report of gesulkumab used and review // Dermatology online journal. 2018. Vol. 24, No. 11. 13030/qt3db748cg.

66. Paparizos V., Rallis E., Kirsten L., Kyriakis K. Ustekinumab for the treatment of HIV psoriasis // The Journal of dermatological treatment. 2012. Vol. 23, No. 6. P. 398–399. https://doi.org/10.3109/09546634.2011.579085.

67. Saeki H., Ito T., Hayashi M. et al. Successful treatment of ustekinumab in a severe psoriasis patient with human immunodeficiency virus infection // Journal of the European Academy of Dermatology and Venereology: JEADV. 2015. Vol. 29, No. 8. P. 1653–1655. https://doi.org/10.1111/jdv.12531.

68. Bardazzi F., Magnano M., Campanati A. et al. Biologic Therapies in HIV-infected Patients with Psoriasis: An Italian Experience // Acta dermato- venereologica. 2017. Vol. 97, No. 8. P. 989–990. https://doi.org/10.2340/00015555-2698.

69. Wang D.M., Fernandez A.P., Calabrese C.M., Calabrese L.H. Treatment of psoriasis with ustekinumab in a patient with HIV-related Kaposi sarcoma // Clinical and experimental dermatology. 2019. Vol. 44, No. 1. P. 113–115. https://doi.org/10.1111/ced.13630.

70. Cepeda E.J., Williams F.M., Ishimori M.L. et al. The use of anti-tumour necrosis factor therapy in HIV-positive individuals with rheumatic disease // Annals of the rheumatic diseases. 2008. Vol. 67, No. 5. P. 710–712. https://doi.org/10.1136/ard.2007.081513.

71. Wangsiricharoen S., Ligon C., Gedmintas L. et al. Rates of Serious Infections in HIV-Infected Patients Receiving Tumor Necrosis Factor Inhibitor Therapy for Concomitant Autoimmune Diseases // Arthritis care research. 2017. Vol. 69, No. 3. P. 449–452. https://doi.org/10.1002/acr.22955.

72. Narcisi A., Bernardini N., Orsini D. et al. Long-term safety and efficacy of adalimumab in psoriasis: a multicentric study focused on infections (connecting study) // Postepy dermatologii i alergologii. 2020. Vol. 37, No. 3. P. 428–434. https://doi.org/10.5114/ada.2020.96910.

73. Liang S.J., Zheng Q.Y., Yang Y. L. et al. Use of etanercept to treat rheumatoid arthritis in an HIV-positive patient: a case-based review // Rheumatology international. 2017. Vol. 37, No. 7. P. 1207–1212. https://doi.org/10.1007/s00296-017-3690-9.

74. Marcelin A.G., Aaron L., Mateus C. et al. Rituximab therapy for HIV-associated Castleman disease // Blood. 2003. Vol. 102, No. 8. P. 2786– 2788. https://doi.org/10.1182/blood-2003-03-0951.

75. Zalmanovich A., Ben-Ami R., Rahav G. et al. Rituximab identified as an independent risk factor for severe PJP: A case-control study // PloS Оne. 2020. Vol. 15, No. 9. P. e0239042. https://doi.org/10.1371/journal.pone.0239042.

76. Habbous S., Guo H., Beca J. et al. The effectiveness of rituximab and HIV on the survival of Ontario patients with diffuse large B-cell lymphoma // Cancer medicine. 2020. Vol. 9, No. 19. P. 7072–7082. https://doi.org/10.1002/cam4.3362.

77. Hoff P., Walther M., Wesselmann H. et al. Erfolgreiche Behandlung eines adulten Morbus Still mit Tofacitinib bei einer HIV-2-positiven Patientin [Successful treatment of adult Still’s disease with tofacitinib in a HIV-2 positive female patient] // Zeitschrift fur Rheumatologie. 2020. Vol. 79, No. 10. P. 1046–1049. https://doi.org/10.1007/s00393-020-00853-9.