ANCA-associated vasculitis in a middle-aged woman with HIV: a complex interplay and therapeutic challenges

Advancements in antiretroviral therapy (ART) have significantly improved the survival of HIV-infected individuals but have also altered the landscape of HIV-associated renal diseases. While HIV-associated nephropathy incidence has decreased, other renal complications have emerged due to ART-related nephrotoxicity, coinfections, comorbidities and immune dysregulation. Antineutrophil cytoplasmic antibodies (ANCAs) have been detected in HIV-infected patients, with prevalence varying significantly (13%-83%) depending on factors such as disease stage and methodology. Recent studies reported a prevalence of approximately 13% ANCA positivity in HIV patients with stable immunovirological status on ART, indicating a lower prevalence in this subgroup. Despite this variability, clinically significant ANCA-associated vasculitis (AAV) remains rare. We report the case of a woman in her 40s with stable HIV infection who developed systemic microscopic polyangiitis with severe renal impairment. Despite complexity, she achieved remission with methylprednisolone, plasma exchange and cyclophosphamide. This case underscores the clinical importance of recognising genuine AAV among HIV patients, particularly following ART regimen changes, emphasising early identification and tailored management.