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Volume 48, Number 2, April 2015

Autoimmune diseases-related arthritis in HIV-infected patients in the era of highly active antiretroviral therapy 


Jen-Jia Yang, Mao-Song Tsai, Hsin-Yun Sun, Szu-Min Hsieh, Mao-Yuan Chen, Wang-Huei Sheng, Shan-Chwen Chang


Received: April 30, 2013    Revised: August 1, 2013    Accepted: August 9, 2013   

 

Corresponding author:

Wang-Huei Sheng
Correspondence
Corresponding author. Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan. 



 

Background and purpose: 

Autoimmune diseases-related arthritis has been rarely reported in HIV-1-infected patients. We aimed to investigate the incidence and clinical manifestations of autoimmune diseases-related arthritis in HIV-infected patients in the era of highly active antiretroviral therapy (HAART) in Taiwan. 



 

Methods:

We retrospectively reviewed medical records of all HIV-infected patients who had a diagnosis of autoimmune arthritis between 1993 and 2013. Demographic characteristics, clinical manifestations, serial CD4 and CD8 lymphocyte counts and plasma HIV viral loads, HLA-B27 status, and treatment response to HIV and rheumatic diseases were recorded. 



 

Results:

During the 20-year study period, totally 26 HIV-infected patients with autoimmune arthritis (0.7%) were diagnosed among 3623 HIV-infected patients. There were 18 patients with ankylosing spondylitis (AS), six with rheumatoid arthritis (RA), one with psoriatic arthritis, and one with Sjögren's syndrome. HLA-B27 antigens were all detected positive of AS patients. Fifteen patients (57.7%) developed autoimmune arthritis after HAART was initiated. The median age and CD4+ T lymphocyte counts at the diagnosis of autoimmune arthritis were 35 (20–62 years) and 406 (3–695 cells/μL), respectively. Three patients had typical presentations of Reiter's syndrome. Both AS and RA patients achieved a good virological response with undetectable plasma HIV RNA load 12 months after receiving HAART(85.71% vs. 80%, respectively, p = 0.999). The treatment response to antirheumatic medications were similar between AS patients and RA patients (77.8% vs. 50%, p = 0.3068), but seems to be better than that reported for the general population (30–40%). 



 

Conclusion:

A low prevalence of autoimmune arthritis among HIV-infected patients in the era of HAART was similar to that of the general Taiwanese population. Clinical manifestations of HIV-infected patients were similar to those described in HIV-uninfected patients. However, the treatment response to antirheumatic agents was better in HIV-infected patients in our study. 



 

Key words:

Autoimmune disease, Highly active antiretroviral therapy, Human leukocyte antigen