Anca-Associated Vasculitis in a Hiv-Infected Patient: A Case Based-Review

Abstract

Background: The occurrence of autoantibodies in HIV-infected patients has been previously reported with a prevalence ranging from 20 to 83%. There are also few reports of clinically-relevant autoantibodies 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, admitted in our department for the evaluation of an acute kidney injury and a nephrotic syndrome with active urinary sediment. A diagnosis of systemic ANCA-associated vasculitis with renal and pulmonary involvement was established. The patient was treated with cyclophosphamide, rituximab and tapering glucocorticoids with resolution of the diffuse alveolar hemorrhage, but the evolution of kidney function was unfavourable, that led to the need to initiate haemodialysis. We highlight the importance of establishing the correct diagnosis, treating accordingly the disease and also the possible clinical issues that can appear in a patient with HIV infection during the immunosuppressant treatment as induction treatment. Also, we performed a thorough literature review of ANCA positivity in HIV-infected patients in order to properly understand the current evidence. Conclusions: Although it is not clear whether HIV infection and ANCA-associated vasculitis are causally or coincidentally related, the possible systemic autoimmune phenomena should be acknowledged by physicians in order to establish the correct diagnosis and treat accordingly the disease by keeping a balance between the risks and benefits of immunosuppression in this category of patients, with the treatment decisions being taken in a multidisciplinary team in centre’s with experience in ANCA-associated vasculitis.

Granulomatosis with polyangiitis or its mimic? A case report

“…17 In a recent review, the rate of ANCA positivity in HIV-infected patients ranged from 13% to 83%; however, clinical vasculitis was absent in most patients, and only one patient showed sinusitis. 18 In our patient, the HIV positivity was diagnosed simultaneously with the systemic ANCA-associated vasculitis, and HAART was started without delay. The CD4 cell count remained normal, and the HIV-1 RNA copy numbers detected by real-time polymerase chain reaction were consistently low (<20 copies/mL).…”