Antiphospholipid syndrome induced by HIV

Leder, Adena; Flansbaum, Bradley; Zandman-Goddard, G; Asherson, Ronald A.; Shoenfeld, Yehuda

doi:10.1191/096120301669209574

Cited by 66 publications

(41 citation statements)

References 27 publications

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“…In general, elevations of aPL in our "normal" CSF samples were observed in patients with conditions previously associated with aPL, for example, infarctions (Levine et al, 2002), MS and demyelinating diseases (Baraczka et al, 2002), and HIV (Leder et al, 2001). The association of aPL with structural brain lesions such as a tumor is not altogether surprising, as this has been reported in rare cases (Liu et al, 1999).…”

Section: Discussionsupporting

confidence: 59%

Testing for Antiphospholipid Antibody (aPL) Specificities in Retrospective “Normal” Cerebral Spinal Fluid (CSF)

Sokol

Wagenknecht

McIntyre

2004

Journal of Immunology Research

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Antiphospholipid antibodies (aPL) have been found in the blood of patients with systemic and neurological disease. The rare reports of aPL in cerebral spinal fluid (CSF) have been limited mostly to IgG and IgM anticardiolipin (aCL). Our published finding of IgA aPE in the CSF of a young stroke victim prompted us to establish "normal" CSF aPL values for a panel of aPL, which included aCL, antiphosphatidylserine (aPS), antiphosphatidylethanolamine (aPE) and antiphosphatidylcholine (aPC). CSF samples were tested by ELISA for IgG, IgM and IgA aPL. In addition, the CSF samples were tested for activity in the presence and absence of phospholipid (PL) binding plasma-proteins. A total of 24 data points were obtained for each CSF sample. We tested 59 CSF samples obtained from 59 patients who were undergoing evaluation for systemic or neurologic diseases. All CSF samples had normal protein, glucose and cell counts. Ten of the 59 CSF samples (17%) had elevated aPL optical density (OD) values an order of magnitude higher than the other 49 CSF samples for one or more aPL specificity and/or isotype. One CSF sample had both PL-binding protein dependent and independent IgG aPE activity. Another CSF sample showed both IgG aPE and aPC reactivity. The remaining eight CSF samples showed single aPL findings; IgG aPE (5), IgG aPC (1), IgG aCL (1) and IgM aPC (1). Seven of 10 patients with elevated CSF values were females. As expected, most "normal" aPL OD values were substantially lower in CSF than those we have reported in blood samples from volunteer blood donors. Jacobson et al., 1999). The associations of aPL with neurologic conditions other than thromboocclusive events have been considered "weak" and attributable to an "epiphenomenon" rather than to pathophysiologic mechanisms (Brey, 2000). A stronger association between aPL and neurological disorders might be easier to establish if aPL are sought and detected in the cerebral spinal fluid (CSF) of patients experiencing neurologic symptoms. Historically, scarce reports of aPL in CSF are limited mostly to IgG and IgM anticardiolipin (aCL) detection (Marchiorri, 1990;Lolli et al., 1991;Wang et al., 1992;Gallo et al., 1994;Yeh et al., 1994;Martinez-Cordero, 1997;Jedryka-Goral et al., 2000;Lai and Lan, 2000;Baraczka et al., 2002). Rarely are IgA aCL sought (Wang et al., 1992). To our knowledge only one report included testing for IgG and IgM antiphosphatidylserine (aPS) and antiphosphatidylethanolamine (aPE) in CSF; the results were negative (Gallo et al., 1994). Our finding of IgA aPE in the CSF of a young stroke victim (Sokol et al., 2000), together with our intent to continue testing additional CSF samples, prompted us to undertake and establish "normal" aPL values for CSF. Our findings form the basis of this report. PATIENTS AND METHODSBecause of the potential risks associated with spinal taps to healthy individuals we were unable to obtain CSF samples from random donors. We opted to perform a retrospective analysis using residual CSF that was collected for diagnostic purposes a...

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Section: Discussionsupporting

confidence: 59%

Testing for Antiphospholipid Antibody (aPL) Specificities in Retrospective “Normal” Cerebral Spinal Fluid (CSF)

Sokol

Wagenknecht

McIntyre

2004

Journal of Immunology Research

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“…Our patient's multiple major clinical events corresponded temporally with the increase in viral load after antiretroviral therapy was discontinued, and no other etiology was apparent despite extensive investigations. Thrombotic events with detection of anticardiolipin antibodies have been reported in association with acute HIV infection [12], and a similar process may have occurred in our patient in association with high-level virologic rebound.…”

Section: Note Art Antiretroviral Therapy; Sti Sexually Transmittedmentioning

confidence: 78%

Retroviral Rebound Syndrome with Fatal Outcome after Discontinuation of Antiretroviral Therapy

Garlin

Sax

2005

Clinical Infectious Diseases

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“…Skin necrosis was also recently reported (Leder et al, 2001) in a male patient with HIV who suffered from testicular infarction requiring orchidectomy. A 42-year-old female who had a 12-year history of HIV infection and who developed gangrene of both forefeet was also reported (Cailleux et al, 1999).…”

Section: Human Immunodeficiency Virus (Hiv)mentioning

confidence: 91%

Antiphospholipid syndrome associated with infections: clinical and microbiological characteristics

Cervera¹,

Asherson²

2005

Immunobiology

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Antiphospholipid syndrome induced by HIV

Cited by 66 publications

References 27 publications

Testing for Antiphospholipid Antibody (aPL) Specificities in Retrospective “Normal” Cerebral Spinal Fluid (CSF)

Testing for Antiphospholipid Antibody (aPL) Specificities in Retrospective “Normal” Cerebral Spinal Fluid (CSF)

Retroviral Rebound Syndrome with Fatal Outcome after Discontinuation of Antiretroviral Therapy

Antiphospholipid syndrome associated with infections: clinical and microbiological characteristics

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