HIV Infection and Clinical Spectrum of Associated Vasculitides

Abstract

Various infections have been causative in the pathogenesis of systemic vasculitides, and HIV infection is not spared. In an immunocompromised host, cytomegalovirus, Epstein-Barr virus, varicella zoster virus, herpes simplex virus, hepatitis B and hepatitis C virus, and mycobacteria, along with HIV infection can cause vasculitis. Herein we emphasize the spectrum of vasculitides, their pathogenesis, presentation, course, and therapy in the HIV-infected population. Every spectrum and size of the blood vessel involvement have been seen in HIV-associated vasculitides. We review each spectrum in detail and describe our experience with polyarteritis nodosa, the most common presentation occurring in HIV-infected patients. We also discuss the differences in HIV, hepatitis B, and hepatitis C- related polyarteritis nodosa in detail.

Polyarteritis Nodosa

“…Subacute bacterial endocarditis (including mycotic aneurysms with distal embolization), as well as HBV, HCV, and HIV, are among the infectious diseases that can mimic vasculitis or cause vascular inflammation. 3,20,[35][36][37] Atherosclerosis, embolic disease from atrial myxomas or cholesterol deposits, segmental arteriolysis medial, calciphylaxis lesions, thrombotic disorders (antiphospholipid syndrome), fibromuscular dysplasia, and ergot use can mimic vasculitis of medium-sized arteries. 41,42 If disease affects the central nervous system, Moyamoya disease, MELAS (mitochondrial encephalomyopathy, lactic acidosis, and strokelike episodes), CADASIL (cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy), and granulomatous angiitis of the central nervous system are considerations.…”

Vulval Tuberculosis: The Histomorphological Spectrum in Patients with HIV Co-Infection and AIDS

“…Despite the heightened recognition of the spectrum of HIV-related infective vasculitic and vasculopathic reactions, the pathogenesis thereof remains enigmatic [59,60]. HIV-induced endothelial dysfunction, vascular wall injury, increased viral load and associated increase in inflammatory cytokines and tumour necrosis factor-α have been proposed [59,60]. Leucocytoclastic and granulomatous vasculitis, manifestations of type III and type IV hypersensitivity reactions [62], respectively, were present in 12 and 1 biopsy each, respectively, in the present study.…”

“…Leucocytoclastic vasculitis may be caused by a range of viral, fungal, bacterial and parasitic diseases. While M.Tb and HIV may cause vascular pathology independently by several mechanisms, the presence of vasculitis in the context of TB and HIV co-infection is poorly reported [54][55][56][57][58][59][60][61][62]. The co-occurrence of TB and vasculitis was first reported in 1967 [55].…”

“…The 3 main presentations of cutaneous vasculitis, described in the context of pulmonary TB, are cutaneous leucocytoclastic vasculitis, Henoch Schonlein purpura and rifampicin-induced vasculitis [55]. Despite the heightened recognition of the spectrum of HIV-related infective vasculitic and vasculopathic reactions, the pathogenesis thereof remains enigmatic [59,60]. HIV-induced endothelial dysfunction, vascular wall injury, increased viral load and associated increase in inflammatory cytokines and tumour necrosis factor-α have been proposed [59,60].…”

Polyarteritis nodosa (PAN): is it a single disease?

“…[9] Di¤er taraftan olgu raporlar› fleklinde olsa da hepatit C virüsü ve HIV ile iliflkili olgular da bildirilmifltir. [10,11] Bu hasta grubu son Chapel Hill konferans›nda 'vaskülit iliflkili olas› nedenler' grubunda yer almaktad›r.…”