Rheumatic Complications of Human Immunodeficiency Virus Infection in the Era of Highly Active Antiretroviral Therapy: Emergence of a New Syndrome of Immune Reconstitution and Changing Patterns of Disease
| Autor: | Leonard H. Calabrese, Elizabeth Kirchner, Rabin K. Shrestha |
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| Rok vydání: | 2005 |
| Předmět: |
Adult
Male medicine.medical_specialty Anti-HIV Agents Population Arthritis HIV Infections Disease Arthritis Rheumatoid Psoriatic arthritis Rheumatology Antiretroviral Therapy Highly Active Internal medicine medicine Humans Reactive arthritis education education.field_of_study business.industry Immunity HIV Syndrome medicine.disease Connective tissue disease Anesthesiology and Pain Medicine Immunology business Rheumatism Follow-Up Studies |
| Zdroj: | Seminars in Arthritis and Rheumatism. 35:166-174 |
| ISSN: | 0049-0172 |
| DOI: | 10.1016/j.semarthrit.2005.03.007 |
| Popis: | OBJECTIVE To describe the impact of the introduction of highly active antiretroviral therapy (HAART) on the nature and frequency of rheumatic complications in human immunodeficiency virus (HIV)-infected patients. METHODS Case report and systematic review of a newly described syndrome of rheumatic immune reconstitution syndrome and prospective longitudinal cohort study analyzing the frequency and nature of rheumatic complications in the setting of HIV infection from 1989 through 2000. RESULTS A newly described syndrome of either the de novo appearance or the exacerbation of clinically occult autoimmunity following immune reconstitution from HAART is described. Including the present case report, 32 cases have been individually described with sarcoidosis and autoimmune thyroid disease being most common with arthritis and various forms of connective tissue disease making up the rest. The mean onset to their appearance following HAART was nearly 9 months and most resolved with little or no therapy. In addition, a longitudinal analysis of 395 HIV-infected patients from 1989 to 2000 designed to detect the appearance of rheumatic complications has revealed a dramatic decline in certain problems such as reactive arthritis, psoriatic arthritis, and various forms of connective tissue disease. New rheumatic complications possibly due to the effects of longer survival and metabolic derangements associated with this form of therapy are now being described and may become more formidable problems in this population in the future. CONCLUSIONS HAART has had a profound beneficial effect on survival in HIV-infected patients but has also contributed to both an altered frequency and a different nature of rheumatic complications now being observed in this population. Rheumatologists need to be aware of these changes to provide optimal diagnosis and treatment for this group. |
| Databáze: | OpenAIRE |
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