Concomitant systemic lupus erythematosus and HIV: Case series and literature review

• Published in: Seminars in arthritis and rheumatism 2014-10, Vol.44 (2), p.186-194
• Main Authors: Mody, Girish M., MD (Cape Town), FCP (SA), FRCP (London), Patel, Neeta, FCP (SA), Budhoo, Amritha, FCP (SA), Dubula, Thozama, FCP (SA)
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; AIDS; Anti-retroviral therapy; Antiretroviral Therapy, Highly Active; Child; Child, Preschool; Comorbidity; Female; HAART; HIV; HIV Infections - drug therapy; HIV Infections - epidemiology; HIV Infections - physiopathology; Humans; Immune reconstitution inflammatory syndrome (IRIS); Infant; Lupus Erythematosus, Systemic - drug therapy; Lupus Erythematosus, Systemic - epidemiology; Lupus Erythematosus, Systemic - physiopathology; Male; Middle Aged; Prevalence; Rheumatology; South Africa; Systemic lupus erythematosus; Treatment Outcome; Young Adult
• ISSN: 0049-0172; 1532-866X
• DOI: 10.1016/j.semarthrit.2014.05.009

Abstract Objectives To determine the effect of systemic lupus erythematosus (SLE) and human immunodeficiency virus (HIV) infection on the course of each other and to review the published reports on concomitant SLE and HIV infection. Methods We performed a retrospective review of the records of patients with SLE and HIV seen in the Department of Rheumatology at the Inkosi Albert Luthuli Central Hospital, Durban, South Africa. We used the terms “systemic lupus erythematosus” and “HIV” or “AIDS” to identify patients with SLE and HIV infection reported in the English medical literature. Results We identified 13 patients with SLE and HIV infection. All the patients were females and there were 11 African blacks and 2 Indians. SLE and HIV infection were diagnosed together in 6 patients. In this group, there were 5 lupus flares in 4 patients, and 2 of the flares followed highly active anti-retroviral treatment (HAART). Five patients developed HIV after the diagnosis of SLE. The 3 patients in whom follow-up data was available had inactive SLE, one of whom was on HAART. Two HIV-positive patients developed SLE after receiving HAART for 30 and 35 mo. Seven of our patients also had tuberculosis. Our literature search identified 58 previously reported patients with HIV and SLE. Conclusion Our case series and review of the literature show that there is a reduction in SLE disease activity in patients with concomitant SLE and HIV. However, when lupus flares occur in HIV-positive patients, they are unrelated to the use of HAART.