Anti-Nuclear, Anti-Neutrophil Cytoplasmic and Anti-Glomerular Basement Membrane Antibodies in Hiv-Infected Individuals

Abstract

Many autoantibodies have been described in HIV-infected individuals. We have examined the incidence, associations and prognostic significance of anti-nuclear antibodies (ANA), anti-neutrophil cytoplasmic antibodies (ANCA) and anti-glomerular basement membrane (GBM) antibodies in individuals with HIV infections. One hundred and five patients, with asymptomatic infections (n = 37), AIDS-related complex (n = 32) or AIDS (n = 36) were studied. Plasma from 24 of these (23%) were positive for ANA: most demonstrated speckled fluorescence (n = 21) and were of low titre (1+ in 18). ANCA were demonstrated by IIF in 18 individuals (17%) and all fluorescent patterns were seen; 6 of these plasma were also positive in the ELISAs for antibodies to proteinase 3, myeloperoxidase or elastase. Thirteen plasma were positive for ANCA in the neutrophil cytoplasm ELISA; 10 of these were also positive in the specific ELISAs. A total of 30 plasma bound to proteinase 3, myeloperoxidase or elastase in specific ELISAs, in 6 cases with 2 specificities. Finally, 18 plasma (17%) contained anti-GBM antibodies by ELISA, but none of 4 plasma tested in inhibition assays was specific. ANA, ANCA and anti-GBM antibodies were not uncommon in HIV-infected individuals but the presence of these antibodies was not associated with the clinical manifestations of the corresponding autoimmune diseases. In addition, there was no correlation between the demonstration of these antibodies and the immunological status of the individual (apart from a correlation between CD4 counts less than 400/microliters with anti-GBM antibodies), the presence of an opportunistic infection, the development of malignancy or reduced survival. Some of these antibodies may arise from polyclonal activation, or be due to "sticky" serum since we have shown that the presence of anti-GBM antibodies correlated with the demonstration of ANCA by ELISA. These antibodies are not more common in hypergammaglobulinemic plasma but some may be due to heat-treatment of the plasma. The clinician caring for HIV-infected individuals needs to be aware of these "false-positive" antibody results.

Anti-glomerular basement membrane glomerulonephritis in an HIV positive patient: case report

“…Some findings reinforce the idea that the association described in this case is not casual, such as: crescentic glomerulonephritis is not common in HIV-positive patients [26], anti-GBM glomerulonephritis is rare and anti-GBM antibodies are frequently observed in HIV-positive subjects when compared to the overall population [26].…”

“…On the other hand, Savige et al [26] found anti-GBM antibodies in 17% of HIV-positive patients, with a significant correlation between the presence of the antibody and CD 4 counts lower than 400/mL. Also, antinuclear antibodies were found in 23% and ANCA in 17% of the HIV-positive subjects.…”

“…It is intriguing that anti-GBM glomerulonephritis has not been reported more frequently in HIV-patients, due to the number of these patients with anti-GBM antibodies in their serum and that these antibodies have a recognized pathogenetic role in such glomerulonephritis [26]. Based on our case report and on the elevated frequency of positivity for such antibodies in this group of patients, it is advisable to be aware of a possible association between these two conditions and to promote an active search for anti-GBM antibodies in HIV-positive subjects.…”

Treatment of HIV-Associated Nephropathies

“…On the other hand, although antineutrophil cytoplasmic antibodies (ANCA) are frequently found in the sera of HIV-positive patients, with a frequency varying from 18 to 41.0%, no correlation has been found between ANCA positivity and the presence of clinically active vasculitis in these patients [22,23,24]. In the majority of these cases, immunofluorescence reveals an atypical ANCA pattern.…”

Penfigóide Bolhoso Refractário em Paciente Infectado pelo Vírus da Imunodeficiência Humana

“…5 O papel direto das partículas virais, os complexos imunes gerados, a desregulação na interação de linfócitos B/T, 6 o mimetismo molecular, 7 a ativação policlonal de linfócitos B poderiam favorecer a síntese de auto-anticorpos, que estão presentes em 23% dos pacientes infectados pelo VIH. 8 Segundo Iordache L et al estas doenças auto-imunes ocorrem sobretudo no contexto de bom controle imunológico (uso de TARV), como no presente caso, e mesmo durante a síndrome de reconstituição imune. 9 Outros autores consideram esta associação casual, em face da prevalência significativa de infecção pelo VIH e a raridade da concomitân-cia com doença autoimune.…”