HIV Spectrum and Autoimmune Diseases

The notion of autoimmune disease in the immunodeficient patient with human immunodeficiency virus (HIV) infection or acquired immunodeficiency syndrome is captivating. We previously suggested a four-stage theory in which autoimmune diseases are mostly encountered during initial HIV infection and after treatment with highly active antiretroviral therapy (HAART). The prevalence of autoimmune disease due to immune reconstitution inflammatory syndrome after HAART treatment has increased. This review updates the clinical findings of autoimmune disease in patients with HIV, focusing on systemic lupus erythematosus (SLE), through the progression of HIV infection (stages I and II) to AIDS (stage III) to immune restoration after HAART (stage IV), and explores possible mechanisms for autoreactivity. More than 300 HIV/AIDS patients with various autoimmune diseases are described. The distribution of autoimmune diseases in the stages of HIV infection confirms our original four-stage theory in which autoimmune diseases occur without profound immunosuppression.