Background Autoimmune diseases (AD) in patients with HIV have been observed since the beginning of the HIV/AIDS pandemic. Epidemiologic studies have reported a prevalence of rheumatic and autoimmune manifestations ranging from 1–72%, including only systemic (SAD) and articular AD (AAD), and not organ-specific AD (OSAD). Prevalence of AD in patients with HIV infection in Mexico has not been fully addressed.
Objectives The aim of this study was to assess the prevalence of AD in HIV-infected patients.
Methods We performed a retrospective study in two tertiary referral centers in Mexico. All subjects seen from june 15th 2003 to june 15th 2014 with a confirmed diagnosis of HIV infection and a diagnosis of an AD were included. We extracted demographic data, HIV infection history, and AD history from the clinical record
Results A total of 5876 HIV-infected patients were seen during the study period. Eighty one AD were found in 77 patients (prevalence: 1.31%). Eight (9.9%) were SAD, 12 (14.8%) AAD and 61 (75.3%) OSAD (Table 1). Four patients (5.2%) had 2 AD. Fifty eight were male (75.3%). Mean age at diagnosis of AD was 34.8 years. In twenty two (27.2%) AD preceded HIV infection, in 23 (28.4%) HIV infection was diagnosed simultaneously with the AD, in 36 (44.4%) AD developed after HIV infection. Mean CD4 T lymphocyte count in patients with a simultaneous diagnosis of HIV infection and AD was 287 cel/μl, only one with undetectable viral load; mean CD4 T lymphocyte count in patients who developed AD after HIV infection was 353 cel/μl, half with undetectable viral load. Sixteen patients were classified with AIDS at AD diagnosis. Five (6.2%) AD were a consequence of immune reconstitution inflammatory syndrome (IRIS); prevalence of autoimmune IRIS was 0.08%. Prevalence of HBV and HCV coinfection was 5.2% and 2.6% respectively. Immunosuppressive treatment was used in 87% of patients.
Conclusions This is the first study to address solely AD without combining non-autoimmune musculoskeletal entities and the largest cohort to date. Prevalence of AD in HIV-infected patients in Mexico was low (1.31%) and OSAD was the most frequent. AD were diagnosed in all stages of HIV infection. Prevalence of HBV and HCV coinfection and autoimmune IRIS was very low. Prospective studies are needed to identify risk factors for the development of autoimmune IRIS.
Patel N, Patel N, Espinoza LR. HIV infection and rheumatic diseases: the changing spectrum of clinical enigma. Rheum Dis Clin North Am. 2009;35(1):139–161.
Disclosure of Interest None declared