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Autoimmune Disease in HIV — SCE Infectious Diseases MCQ

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HardHIV MedicineAutoimmune Disease in HIVSCE Infectious Diseases

A 35-year-old woman with HIV (CD4 620, VL <50 on ART for 5 years) develops a classic malar rash, arthralgia, and positive ANA/anti-dsDNA. She is diagnosed with systemic lupus erythematosus. What is the relationship between HIV and autoimmune disease?

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Correct answer: A — Autoimmune diseases including SLE can emerge during immune reconstitution on ART — this is a recognised phenomenon as CD4 recovery restores autoreactive T-cell function

Autoimmune diseases (SLE, RA, sarcoidosis, Graves disease, autoimmune hepatitis) can emerge or flare during immune reconstitution on ART. This is thought to reflect restoration of autoreactive T-cell clones that were depleted or suppressed during uncontrolled HIV. It is considered a form of non-infectious IRIS. Management follows standard rheumatological guidelines. Some immunosuppressants (Hydroxychloroquine, Methotrexate) can generally be used safely in well-controlled HIV with appropriate monitoring.

Reference: BHIVA 2022 – Autoimmune disease in HIV; Lancet HIV 2020