HIV-infection and rheumatic diseases: the current state of the problem

Abstract

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.