Servicio de Reumatología, Hospital Central de la Fuerza Aérea, Lima, Peru.
Louisiana State University Health Sciences Center, 433 Bolivar St, New Orleans, LA 70112, USA.
Pharmacol Res. 2018 Mar;129:1-9. doi: 10.1016/j.phrs.2018.01.005. Epub 2018 Jan 10.
More than 35 years have elapsed since the initial outbreak of the HIV/AIDS epidemic and the status of a considerable number of patients has changed from a fatal disorder to a chronic one where comorbidities including sarcoidosis and autoimmune diseases have become relevant and dominant. HIV targets the immune system leading to a state of immunodeficiency in a setting of immune activation in which CD4 T cell depletion plays a critical role. The onset, natural history and course of HIV-associated autoimmune disease has dramatically changed according to the stage of HIV infection and since the introduction of combined anti-retroviral therapy. There are some issues that need further study regarding therapy, especially when immunosuppressive drugs and biologic agents are under consideration. Currently, biologic agents and others immunosuppressive agents are recommended when patients have CD4 T cell counts above 200 cells/mm and the HIV viral activity is completely suppressed.
自艾滋病疫情首次爆发以来，已经过去了 35 多年，许多患者的病情已经从致命疾病转变为慢性疾病，包括结节病和自身免疫性疾病等合并症变得相关和突出。HIV 攻击免疫系统，导致免疫激活状态下的免疫缺陷，其中 CD4 T 细胞耗竭起着关键作用。根据 HIV 感染阶段和联合抗逆转录病毒治疗的引入，HIV 相关自身免疫性疾病的发病、自然史和病程发生了显著变化。在考虑免疫抑制药物和生物制剂时，治疗方面仍有一些问题需要进一步研究。目前，当患者的 CD4 T 细胞计数高于 200 个/立方毫米且 HIV 病毒活性完全被抑制时，建议使用生物制剂和其他免疫抑制剂。
