The aim of the present study was to investigate the possible role of human immunodeficiency virus (HIV) infection in the natural course of chronic hepatitis C. Seventy-six adult patients with chronic parenterally acquired hepatitis C virus (HCV) infection examined from 1989 to 1993 were enrolled; of these 32 (42.1%) were HIV positive and 44 (57.9%) were HIV negative. Serum HCV RNA quantitation was carried out by polymerase chain reaction in a well-characterized group (n = 20; 11 HIV positive and 9 HIV negative). Distribution of histological findings in liver biopsies from both HIV-infected and noninfected patients was similar. However, within 15 years after initial HCV infection, 8 of 32 (25%) HIV-positive patients developed cirrhosis, in comparison with only 2 of 31 (6.5%) patients in the HIV-negative group (p < 0.05); similar incidences of cirrhosis were found in both patient groups within 5 and 10 years after HCV infection. Most of the HIV-negative cirrhotic patients (9 of 11) developed cirrhosis in a time interval longer than 15 years. Finally, HCV load was almost ten times higher (1 10-fold dilution) in the HIV-positive group, but this difference did not reach statistical significance in this small study population. These results suggest that HIV infection can alter the natural course of chronic parenterally acquired hepatitis C, causing an unusually rapid progression to cirrhosis.

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Two cases of mucormycosis in patients with exclusively renal involvement and advanced HIV infection are reported. In both cases the clinical course was relatively benign; in one case a tendency towards regression with no specific treatment was observed, and in the other case the infection resolved after nephrectomy and antifungal therapy. Renal mucormycosis should be considered in the differential diagnosis of diffuse renal enlargement in HIV-infected patients.

BackgroundPrimary Sjögren syndrome (pSS) is a systemic autoimmune disease characterized by lymphocyte infiltration of the exocrine glands. Nevertheless, it can affect any organ and develop extra-glandular manifestations that even can precede the typical glandular manifestations and delay the diagnosis.ObjectivesThe aim of our study was to evaluate the extra-glandular manifestations not included in disease activity indexes (Sjogren's Syndrome Disease Activity Index and EULAR Sjogren's Syndrome Disease Activity Index).MethodsWe conducted a multicenter descriptive transversal study of pSS patients fulfilling European/American criteria, from 33 Spanish rheumatology departments. Patients were selected by randomization. Every patient was interviewed for data collection and signed an informed consent. Data were also collected by reviewing medical records. Local ethics committees approved the study. Variables were analysed by descriptive statistical methods, using means, medians and rates. Chi-square was used to establish the statistical associations. A p<0.05 was considered significant.ResultsFour hundred and thirty-seven patients were included. Ninety-five percent of them were women. The median age of the cohort was 58 years. Nineteen percent of the patients referred involvement of the trachea or upper airway. Twenty-one percent of the patients developed Raynaud phenomenon. Twelve (2.7%) patients suffered cardiac impairment (6 pericarditis and 6 cardiac conduction disorders). Thirteen percent of the patients referred digestive involvement, being chronic atrophic gastritis the most frequent condition (21 patients), followed by esophageal motility alteration (12 patients), followed by lymphocytic colitis (3 patients). Seven percent of the patients developed hepatic involvement: primary biliary cirrhosis and autoimmune hepatitis were the most frequent (15 and 14 patients, respectively), followed by autoimmune cholangitis in 3 patients; 55 patients (13%) had anti-LKM antibodies, 15 patients anti-mitochondrial antibodies, and 5 patients anti-smooth muscle antibodies. Seven patients had pancreatic involvement. Seventy-eight patients (18%) had thyroid involvement: anti-thyroid peroxidase (anti-TPO) hypothyroidism was the most frequent (41 patients), followed by subclinical hypothyroidism in 23 patients, negative anti-TPO hypothyroidism in 12 patients, anti-TPO+ hyperthyroidism in one patient and anti-TPO- hyperthyroidism in one patient. Thyroid involvement was significantly more frequently in patients with anti-Ro+. Raynaud phenomenon was significantly more frequent in patients with anti-La antibodies. Digestive involvement was significantly more frequent in patients with low C3. Pancreatic involvement was significantly more frequent in patients with low C3 and C4. Hepatic and trachea involvement were significantly more frequent in patients with hypergammaglobulinemia.ConclusionsTwenty percent of the patients with primary Sjögren syndrome developed extra-glandular manifestations not included in disease activity indexes. Serolo...

Objectives:To investigate the prevalence, risk factors, and effects of primary renal disease on morbidity and mortality in patients with primary Sjögren’s syndrome (pSS).Methods:All patients in the SJÖGRENSER (registry of adult SSp patients of the Spanish Society of Rheumatology, cross-sectional phase) cohort were retrospectively investigated for the presence of clinically significant renal involvement directly related to pSS activity.Results:Of the 437 patients investigated, 39 (9%) presented overt renal involvement during follow-up. Severe renal disease necessitating kidney biopsy was relatively rare (23%).Renal involvement may complicate pSS at any time during the disease course and is associated with severe disease (indicated by higher scores of involvement, activity, and damage), systemic multiorgan involvement, and a higher frequency of lymphoma. Multivariate analysis showed that older age (odds ratio [OR] 1.03, 95% confidence interval [CI] 1.00–1.07), higher European League Against Rheumatism Sjogren’s Syndrome Disease Activity Index scores (OR 1.1, CI 1.03–1.18), serum anti-La/SSB positivity (OR 6.44, CI 1.36–30.37), and non-vasculitic cutaneous involvement (OR 8.64, 1.33–55.90) were independently associated with this complication.Chronic renal failure developed in 23 of 39 patients (59%); only 1 of them progressed to end-stage renal disease necessitating renal replacement therapy. Patients with renal disease showed higher Sjögren’s syndrome disease damage index scores (SSDDI), higher rates of hospitalization due to disease activity and higher rates of clinically relevant comorbidities.Conclusion:Renal involvement is an uncommon complication in pSS that was observed in 9% of patients. Although categorized as a non-negligible comorbidity, this condition shows a favorable prognosis.Disclosure of Interests:None declared