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HIV and autoimmunity.

Gisele Zandman-Goddard1, Yehuda Shoenfeld

  • 1Center for Autoimmune Diseases, Department of Medicine 'B', Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Hashomer 52621, Israel.

Autoimmunity Reviews
|July 10, 2003
PubMed
Summary
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Autoimmune diseases are increasingly observed in patients with human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS). A proposed staging system correlates autoimmune manifestations with HIV/AIDS progression and immune status, aiding therapeutic decisions.

Area of Science:

  • Immunology
  • Infectious Diseases
  • Rheumatology

Background:

  • The association between human immunodeficiency virus (HIV) infection/acquired immunodeficiency syndrome (AIDS) and autoimmune diseases is complex and increasingly recognized.
  • Mechanisms may involve infectious triggers, molecular mimicry, and immune dysregulation, particularly CD8 T-cell driven responses during advanced disease.
  • The advent of highly active anti-retroviral therapy (HAART) has altered the landscape, potentially increasing the incidence of autoimmune conditions.

Purpose of the Study:

  • To explore the spectrum of autoimmune diseases associated with HIV/AIDS.
  • To propose a staging system for autoimmune manifestations based on HIV/AIDS progression, CD4 count, and viral load.
  • To discuss potential mechanisms underlying autoimmune disease development in the context of HIV infection.

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Main Methods:

  • Review of existing literature on autoimmune phenomena in HIV/AIDS patients.
  • Analysis of proposed staging for autoimmune manifestations correlating with disease progression.
  • Discussion of immunological mechanisms, including molecular mimicry and immune reconstitution inflammatory syndrome (IRIS)-like phenomena.

Main Results:

  • Autoimmune diseases can occur at various stages of HIV infection, including acute infection and immune reconstitution after HAART.
  • A proposed staging system categorizes autoimmune manifestations based on immune competence (CD4 count) and viral load.
  • Numerous autoantibodies are reported in HIV/AIDS patients, though their direct association with clinical autoimmune disease requires further establishment.

Conclusions:

  • Autoimmune diseases are a significant and growing concern in the management of HIV/AIDS patients.
  • The proposed staging system may assist in identifying and managing autoimmune conditions in relation to HIV disease progression and therapy.
  • Understanding the interplay between HIV, immune status, and autoimmunity is crucial for optimizing patient care and therapeutic strategies.