ANCA-associated vasculitis in a HIV-infected patient:a case-based review
Abstract Background The occurrence of autoantibodies in human immunodeficiency virus (HIV)-infected patients has been previously reported, with a prevalence ranging from 20 to 83%. There are also a few reports of clinically relevant autoantibody profiles in HIV-positive patients that lead to true sy...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-07-01
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| Series: | BMC Nephrology |
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| Online Access: | https://doi.org/10.1186/s12882-023-03244-9 |
| _version_ | 1797779015692451840 |
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| author | Alexandra Vornicu Bogdan Obrișcă Bogdan Sorohan Andreea Berechet Gener Ismail |
| author_facet | Alexandra Vornicu Bogdan Obrișcă Bogdan Sorohan Andreea Berechet Gener Ismail |
| author_sort | Alexandra Vornicu |
| collection | DOAJ |
| description | Abstract Background The occurrence of autoantibodies in human immunodeficiency virus (HIV)-infected patients has been previously reported, with a prevalence ranging from 20 to 83%. There are also a few reports of clinically relevant autoantibody profiles in HIV-positive patients that lead to true systemic autoimmune disease; these possible life-threatening diseases have to be considered and treated accordingly. Case presentation Here, we present the case of a 29-year-old female patient with a history of well-controlled HIV infection in the last 6 years who was admitted to our department for the evaluation of acute kidney injury and nephrotic syndrome with active urinary sediment. A diagnosis of systemic antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) with renal and pulmonary involvement was established. The patient was treated with cyclophosphamide, rituximab and tapering glucocorticoids,and the diffuse alveolar hemorrhage resolved, but the evolution of kidney function was unfavorable, which led to the need to initiate hemodialysis. We highlight the importance of establishing the correct diagnosis, treating the disease accordingly and the possible clinical issues that can appear in a patient with HIV infection during immunosuppressant treatment as induction treatment. Additionally, we performed a thorough literature review of ANCA positivity in HIV-infected patients to properly understand the current evidence. Conclusions Although it is not clear whether HIV infection and AAV are causally or coincidentally related, the possibility of this systemic autoimmune phenomenon should be acknowledged by physicians to establish the correct diagnosis and treat the disease accordingly by maintaining a balance between the risks and benefits of immunosuppression in this category of patients, with treatment decisions being made by the members of a multidisciplinary team in centers with experience in AAV. |
| first_indexed | 2024-03-12T23:25:40Z |
| format | Article |
| id | doaj.art-e7bdd55ac4ce41cab952352ea97acb4d |
| institution | Directory Open Access Journal |
| issn | 1471-2369 |
| language | English |
| last_indexed | 2024-03-12T23:25:40Z |
| publishDate | 2023-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Nephrology |
| spelling | doaj.art-e7bdd55ac4ce41cab952352ea97acb4d2023-07-16T11:11:56ZengBMCBMC Nephrology1471-23692023-07-012411910.1186/s12882-023-03244-9ANCA-associated vasculitis in a HIV-infected patient:a case-based reviewAlexandra Vornicu0Bogdan Obrișcă1Bogdan Sorohan2Andreea Berechet3Gener Ismail4Department of Nephrology, “Carol Davila” University of Medicine and PharmacyDepartment of Nephrology, “Carol Davila” University of Medicine and PharmacyDepartment of Nephrology, “Carol Davila” University of Medicine and PharmacyDepartment of Nephrology, Fundeni Clinical InstituteDepartment of Nephrology, “Carol Davila” University of Medicine and PharmacyAbstract Background The occurrence of autoantibodies in human immunodeficiency virus (HIV)-infected patients has been previously reported, with a prevalence ranging from 20 to 83%. There are also a few reports of clinically relevant autoantibody profiles in HIV-positive patients that lead to true systemic autoimmune disease; these possible life-threatening diseases have to be considered and treated accordingly. Case presentation Here, we present the case of a 29-year-old female patient with a history of well-controlled HIV infection in the last 6 years who was admitted to our department for the evaluation of acute kidney injury and nephrotic syndrome with active urinary sediment. A diagnosis of systemic antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) with renal and pulmonary involvement was established. The patient was treated with cyclophosphamide, rituximab and tapering glucocorticoids,and the diffuse alveolar hemorrhage resolved, but the evolution of kidney function was unfavorable, which led to the need to initiate hemodialysis. We highlight the importance of establishing the correct diagnosis, treating the disease accordingly and the possible clinical issues that can appear in a patient with HIV infection during immunosuppressant treatment as induction treatment. Additionally, we performed a thorough literature review of ANCA positivity in HIV-infected patients to properly understand the current evidence. Conclusions Although it is not clear whether HIV infection and AAV are causally or coincidentally related, the possibility of this systemic autoimmune phenomenon should be acknowledged by physicians to establish the correct diagnosis and treat the disease accordingly by maintaining a balance between the risks and benefits of immunosuppression in this category of patients, with treatment decisions being made by the members of a multidisciplinary team in centers with experience in AAV.https://doi.org/10.1186/s12882-023-03244-9ANCA vasculitisHIV infectionImmunosuppressionInduction therapy |
| spellingShingle | Alexandra Vornicu Bogdan Obrișcă Bogdan Sorohan Andreea Berechet Gener Ismail ANCA-associated vasculitis in a HIV-infected patient:a case-based review BMC Nephrology ANCA vasculitis HIV infection Immunosuppression Induction therapy |
| title | ANCA-associated vasculitis in a HIV-infected patient:a case-based review |
| title_full | ANCA-associated vasculitis in a HIV-infected patient:a case-based review |
| title_fullStr | ANCA-associated vasculitis in a HIV-infected patient:a case-based review |
| title_full_unstemmed | ANCA-associated vasculitis in a HIV-infected patient:a case-based review |
| title_short | ANCA-associated vasculitis in a HIV-infected patient:a case-based review |
| title_sort | anca associated vasculitis in a hiv infected patient a case based review |
| topic | ANCA vasculitis HIV infection Immunosuppression Induction therapy |
| url | https://doi.org/10.1186/s12882-023-03244-9 |
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