Division of Rheumatology, Albert Einstein College of Medicine, Bronx, NY, USA.
Semin Arthritis Rheum. 2010 Dec;40(3):201-9. doi: 10.1016/j.semarthrit.2009.12.001. Epub 2010 Feb 4.
To describe the unusual occurrence of systemic lupus erythematosus (SLE) with nephritis in human immunodeficiency virus (HIV)-infected individuals.
Chart review-based report of a case of SLE with diffuse proliferative glomerulonephritis (DPGN) in an HIV-infected man, together with a literature review of previously published cases. We searched the English language medical literature from 1987 to 2009 using the following PubMed and Medline terms: "SLE," "HIV," "DPGN." In addition, we researched the role of mycophenolate mofetil (MMF) in the treatment of patients with HIV by using the keywords "MMF" and "HIV".
An 18-year-old male patient with vertically transmitted HIV-1 infection presented with malaise, weight loss, malar rash, arthritis, proteinuria, and hematuria. Kidney biopsy confirmed the diagnosis of lupus nephritis (Class IV). He was treated successfully with high-dose corticosteroids and MMF, which were added to his baseline treatment of highly active antiretroviral therapy. The review of the literature identified a total of 18 cases of SLE appearing in HIV+ individuals, of which 11 patients had lupus nephritis. Among the latter, there were only 5 cases of proliferative (focal or diffuse) glomerulonephritis, and their treatment consisted mainly of high-dose corticosteroids. The short-term outcome was favorable in 4 cases and 1 patient died.
Proliferative lupus nephritis is rare in HIV-infected patients. A detailed analysis of the cases may lead to important insights into the pathogenic mechanisms of both diseases. Considering its complex interaction with antiviral medications, MMF may be considered for the treatment of lupus with severe proliferative glomerulonephritis in HIV-infected individuals.
描述人类免疫缺陷病毒（HIV）感染者中出现系统性红斑狼疮（SLE）合并肾炎的罕见情况。
对 1 例 HIV 感染男性患者出现弥漫性增生性肾小球肾炎（DPGN）的 SLE 病例进行基于图表的回顾性报告，并对之前发表的病例进行文献复习。我们使用以下 PubMed 和 Medline 术语，从 1987 年至 2009 年搜索英文医学文献：“SLE”、“HIV”、“DPGN”。此外，我们使用关键字“MMF”和“HIV”搜索了关于霉酚酸酯（MMF）治疗 HIV 患者的作用的研究。
一名 18 岁男性患者，垂直传播 HIV-1 感染，出现不适、体重减轻、蝶形皮疹、关节炎、蛋白尿和血尿。肾脏活检证实狼疮肾炎（IV 级）的诊断。他成功地接受了大剂量皮质类固醇和 MMF 治疗，这些药物被添加到他的高效抗逆转录病毒治疗的基础治疗中。文献复习共发现 18 例 HIV+个体中出现的 SLE，其中 11 例有狼疮肾炎。在后一组中，仅有 5 例出现增生性（局灶性或弥漫性）肾小球肾炎，其治疗主要包括大剂量皮质类固醇。4 例患者的短期预后良好，1 例患者死亡。
增生性狼疮肾炎在 HIV 感染患者中罕见。对这些病例的详细分析可能会对这两种疾病的发病机制有重要的了解。鉴于其与抗病毒药物的复杂相互作用，MMF 可能被认为是治疗 HIV 感染个体中严重增生性肾小球肾炎的狼疮的一种方法。
