Zandman-Goddard Gisele, Shoenfeld Yehuda
Center for Autoimmune Diseases, Department of Medicine 'B', Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Hashomer 52621, Israel.
Autoimmun Rev. 2002 Dec;1(6):329-37. doi: 10.1016/s1568-9972(02)00086-1.
The association of immune dysfunction in patients with human immunodeficiency virus (HIV) infection and AIDS and the development of autoimmune diseases is intriguing. Yet, the spectrum of reported autoimmune phenomena in these patients is increasing. An infectious trigger for immune activation is one of the postulated mechanisms and derives from molecular mimicry. During frank loss of immunocompetence, autoimmune diseases that are predominantly T cell subtype CD8 driven predominate. There is evidence for B cell stimulation and many autoantibodies are reported in HIV patients. We propose a staging of autoimmune manifestations related to HIV/AIDS manifestations and the total CD4 count and viral load that may be beneficial in identifying the type of autoimmune disease and establishing the proper therapy. In stage I there is the acute HIV infection, and the immune system is intact. In this stage, autoimmune diseases may develop. Stage II describes the quiescent period without overt manifestations of AIDS. However, there is a declining CD4 count indicative of some immunosuppression. Autoimmune diseases are not found. During stage III there is immunosuppression with a low CD4 count and the development of AIDS. CD8 T cells predominant and diseases such as psoriasis and diffuse immune lymphocytic syndrome (similar to Sjogren's syndrome) may present or even be the initial manifestation of AIDS. Also during this stage no autoimmune diseases are found. In stage IV there is restoration of immune competence following highly active anti-retroviral therapy (HAART). In this setting, there is a resurgence of autoimmune diseases. The frequency of reported rheumatological syndromes in HIV-infected patients ranges from 1 to 60%. The list of reported autoimmune diseases in HIV/AIDS include systemic lupus erythematosus, anti-phospholipid syndrome, vasculitis, primary biliary cirrhosis, polymyosits, Graves' disease, and idiopathic thrombocytopenic purpura. Also, there is an array of autoantibodies reported in HIV/AIDS patients which include anti-cardiolipin, anti-beta2 GPI, anti-DNA, anti-small nuclear ribonucleoproteins (snRNP), anti-thyroglobulin, anti-thyroid peroxidase, anti-myosin, and anti-erythropoietin antibodies. The association of autoantibodies in HIV-infected patients to clinical autoimmune disease is yet to be established. With the upsurge of HAART, the incidence of autoimmune diseases in HIV-infected patients is increasing. In this review, we describe the various autoimmune diseases that develop in HIV/AIDS patients through possible mechanisms related to immune activation.
人类免疫缺陷病毒（HIV）感染患者及艾滋病患者的免疫功能障碍与自身免疫性疾病的发生之间的关联引人关注。然而，这些患者中报告的自身免疫现象的范围正在扩大。免疫激活的感染性触发因素是一种推测的机制，源于分子模拟。在免疫能力明显丧失期间，主要由T细胞亚型CD8驱动的自身免疫性疾病占主导。有证据表明HIV患者存在B细胞刺激，并且报告了许多自身抗体。我们提出了一种与HIV/AIDS表现、总CD4计数和病毒载量相关的自身免疫表现分期，这可能有助于识别自身免疫性疾病的类型并确定适当的治疗方法。在第一阶段，存在急性HIV感染，免疫系统完好无损。在这个阶段，可能会发生自身免疫性疾病。第二阶段描述了没有明显艾滋病表现的静止期。然而，CD4计数下降表明存在一定程度的免疫抑制。未发现自身免疫性疾病。在第三阶段，存在免疫抑制，CD4计数低且出现艾滋病。CD8 T细胞占主导，银屑病和弥漫性免疫淋巴细胞综合征（类似于干燥综合征）等疾病可能出现，甚至可能是艾滋病的初始表现。同样在这个阶段，未发现自身免疫性疾病。在第四阶段，经过高效抗逆转录病毒治疗（HAART）后免疫能力恢复。在这种情况下，自身免疫性疾病会再次出现。HIV感染患者中报告的风湿性综合征的发生率在1%至60%之间。HIV/AIDS中报告的自身免疫性疾病包括系统性红斑狼疮、抗磷脂综合征、血管炎、原发性胆汁性肝硬化、多发性肌炎、格雷夫斯病和特发性血小板减少性紫癜。此外，HIV/AIDS患者中报告了一系列自身抗体，包括抗心磷脂、抗β2糖蛋白I、抗DNA、抗小核糖核蛋白（snRNP）、抗甲状腺球蛋白、抗甲状腺过氧化物酶、抗肌球蛋白和抗促红细胞生成素抗体。HIV感染患者中自身抗体与临床自身免疫性疾病的关联尚未确定。随着HAART的兴起，HIV感染患者中自身免疫性疾病的发生率正在增加。在这篇综述中，我们通过与免疫激活相关的可能机制描述了HIV/AIDS患者中发生的各种自身免疫性疾病。
