Immune Restoration Disease After Antiretroviral Therapy

Martyn A. French; Patricia Price; Shelley F. Stone

Disclosures

AIDS. 2004;18(12) 

In This Article

Autoimmune Immune Restoration Disease

Autoimmune diseases presenting for the first time, or as an exacerbation of established disease, have also been reported in HIV patients responding to HAART. Patients with systemic lupus erythematosus, polymyositis or rheumatoid arthritis usually present during the first few months therapy.[131,132,133,134] A patient with relapsing polychondritis and sarcoidosis presented after 2 years.[126] It is presumed that the immune dysregulation underlying the autoimmune disease is precipitated or exacerbated by the immunological changes that occur after suppression of HIV replication. Guillain-Barre syndrome may also present in the first few weeks of HAART.[135,136] CD8 T cells were demonstrated in the endoneurium of brachial plexus nerves in one patient.[136]

Graves' disease is an uncommon but well-recognized complication of immune reconstitution in severely immunodeficient HIV patients.[137,138] It presents later than other autoimmune diseases in patients on HAART and probably has a different pathogenic mechanism. A case study has provided evidence that it may result from thymic dysfunction during immune reconstitution.[139]

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