Effects of human immunodeficiency virus infection on the expression of rheumatic illness

Observations in patients with SLE and RA complicated by HIV-1 infection suggest that the immunodeficient state induced by the virus ultimately leads to improvement of rheumatic symptoms. Although profound CD4 lymphocyte depletion occurred in most of the patients reviewed, it is too simplistic to theorize that CD4 lymphopenia alone was responsible for the clinical improvement. In fact, the third case of RA was notable because arthritis improved at the onset of HIV infection before significant changes in lymphocyte numbers occurred. Human immunodeficiency virus infection has been associated with a wide array of immunoregulatory defects other than lymphocyte depletion. Such immunomodulatory effects may or may not have been responsible for the clinical observations made in the patients described in this article; but delineation of these effects might provide insights into the pathogenesis of rheumatic diseases, as well as potential therapeutic strategies.