Autoimmune blistering disorders in the setting of human immunodeficiency virus infection

Abstract

The interplay between immune dysfunction and human immunodeficiency virus (HIV) is complex. Reports of autoimmune disorders including autoimmune bullous disorders (AIBDs) have been increasing in prevalence in the HIV population since the introduction of highly active antiretroviral therapy in 1995. We offer a literature review of clinical experiences in various AIBDs with particular emphasis on therapeutic management as well as a brief overview of the mechanisms that explain the relationship between AIBD and HIV. Because immunosuppressants are first-line therapies for AIBD treatment, careful consideration is warranted when considering management in the HIV population.

Bullous Pemphigoid: Trigger and Predisposing Factors

“…Furthermore, parasitic diseases, such as Sarcoptes scabiei infestation, may trigger BP as a Koebner phenomenon, but it is very important to differentiate it from a bullous subtype of scabies that could mimic BP [ 107 ]. With few exceptions, where DIF was not performed for different reasons [ 101 , 102 , 103 ], in all the reported cases the diagnosis was confirmed by DIF.…”

“…This could suggest a role of TTV in the pathogenesis of BP. Human Immunodeficiency Virus (HIV) has been associated to BP in three case reports [ 101 ]. In all of them HIV infection preceded the BP onset [ 102 , 103 , 104 ].…”

May Bacterial Infections Trigger Bullous Pemphigoid? Case Report and Review of Literature

“…Human herpesviruses have been found in blister fluid of BP patients [35] and serological association has even been observed [6]. The Torque Teno virus has been selectively found to be associated with BP [36], as well as human immunodeficiency virus (HIV) [37][38][39], hepatitis C virus (HCV) [40], and hepatitis B virus (HBV) [6]. Even coxsackievirus A6 has been reported to be able to induce a BP flare [41].…”

Case of bullous pemphigoid positive for full‐length BP180 ELISA accompanied by immunological reconstitution due to antiretroviral therapy for human immunodeficiency virus infection

“…Several theories have been proposed to explain the development of autoimmunity with HIV infection, including molecular mimicry to a self-antigen, persistent antigen stimulation, and restoration of the immune system with ART. 1 According to the previous reports proposing a clinical staging system to categorize autoimmune disorders in HIV and their relationships to total CD4 counts and viral loads, 1,2 the present case, in which bullous lesions had appeared accompanied by the restoration of CD4 counts after ART (Figure 1c), could be categorized as stage IV (i.e., CD4 >500 with low viral load) and was suggested to be caused by immune reconstitution by ART, as in the reported case, 3 although there was no obvious evidence. Interestingly, the present case improved spontaneously without any treatment, suggesting that the autoimmune disease due to immune reconstitution by ART might disappear depending on the normalization of the immune response.…”