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HIV
Published in John W. Scadding, Nicholas A. Losseff, Clinical Neurology, 2011
A sensory neuropathy, frequently painful, is reported in association with diffuse infiltrative lymphocytosis syndrome (DILS), a condition with similarities to Sjögren’s syndrome, with dry eyes and dry mouth. There is usually evidence of systemic involvement – parotidomegaly, lymphadenopathy or splenomegaly, with a CD8 cell lymphocytosis and CD8 cell infiltration of the nerve. HAART appears to be the most effective treatment, with or without steroids.
HIV and AIDS Pain
Published in Mark V. Boswell, B. Eliot Cole, Weiner's Pain Management, 2005
Maurice Policar, Vasanthi Arumugam
Several types of peripheral neuropathies have been diagnosed in patients with HIV and AIDS (Luciano, Perdo, & McArthur, 2003; Pardo, McArthur, & Griffin, 2001). The following discussion is separated into sections on clinical features, diagnosis, and management. Most can have pain as a component of the condition; however, even those that do not present with pain will be mentioned here for the sake of completeness. They include: Distal symmetrical polyneuropathy (DSP)Antiretroviral toxic neuropathies (ATN)Herpes zoster (HZ) and postherpetic neuralgia (PHN)Mononeuropathy mutiplex (MM)Diffuse infiltrative lymphocytosis syndrome (DILS)Lumbosacral polyradiculopathy (cauda equina syndrome)MononeuropathiesInflammatory demyelinating polyneuropathiesAutonomic neuropathy
A review of renal disease in children with HIV infection
Published in Infectious Diseases, 2018
Ankur Kumar Jindal, Karalanglin Tiewsoh, Rakesh Kumar Pilania
Interstitial nephritis in HIV-infected patients is usually the result of drug side effect, infections and immunological dysregulation. Acute interstitial nephritis was the third most common biopsy diagnosis (seen in 7.9% of all biopsies performed) in one series published by Parkhie et al. [91]. In another biopsy series reported in 2013 by Zaidan et al. [92] including data of 222 biopsies, interstitial nephritis was seen in around 13% of all biopsies. In both series, drugs were the most common etiologic agents followed by infections (especially mycobacterial and cytomegalovirus infections) and immunological dysregulation (immune reconstitution inflammatory syndrome, IRIS and diffuse infiltrative lymphocytosis syndrome, DILS). Two renal biopsy series in children from Johannesburg and Cape Town found interstitial nephritis in 11.5% and 7% of all biopsies performed [36,37]. Cotrimoxazole, non-steroidal anti-inflammatory drugs and protease inhibitors (especially indinavir and ritonavir) are common drugs implicated in causing interstitial nephritis in the setting of HIV infection. Most common clinical presentation is acute kidney injury followed by proteinuria (subnephrotic to nephrotic range), haematuria and leukocyturia. Management includes withdrawal of offending drug, treatment of opportunistic infection and supportive care (maintenance of fluid and electrolyte balance including dialysis). Role of corticosteroids is controversial; however, these may be considered in the setting of IRIS.
Pharmacotherapeutic options for kidney disease in HIV positive patients
Published in Expert Opinion on Pharmacotherapy, 2021
Anam Tariq, Hannah Kim, Hashim Abbas, Gregory M. Lucas, Mohamed G. Atta
AIN has been cited as the third most common diagnosis of kidney injury in PLWH [73,74]. Given its frequency, AIN should be considered in any patient presenting with AKI. Additional risks factors include: exposure to drugs linked with AIN and increased risk for infections/inflammation, such as immune reconstitution inflammatory syndrome (IRIS), diffuse infiltrative lymphocytosis syndrome (DILS), and interstitial inflammation caused by HIV itself [73]. Among PLWH, infections associated with AIN are Tuberculosis, Cryptococcus, Epstein-Barr virus and Adenovirus (Table 3) [75–77]. The gold standard for diagnosis is a kidney biopsy.
Retroviruses in the pathogenesis of systemic lupus erythematosus: Are they potential therapeutic targets?
Published in Autoimmunity, 2020
Rossella Talotta, Fabiola Atzeni, Magdalena Janina Laska
HIV is a retrovirus infecting CD4+ T cells, monocytes, macrophages and dendritic cells after interacting with the surface molecules CD4, C-C chemokine receptor type 5 (CCR5) and C-X-C chemokine receptor type 4 (CXCR-4) [64]. Following the infection of dendritic cells, HIV is then presented and transmitted to CD4+ T lymphocytes, which mature and migrate in regional lymph nodes. Here, HIV replicates into host cells to a sufficient threshold to be spread in bloodstream. Concomitantly, during the first weeks, the development of an acute antiviral response constrains the viraemia, although the virus persists inside host cells. The further course of the infection lies on a balance between the viral load and the host immune response. These viruses can establish a long asymptomatic latency phase, lasting from 8 to 12 years [65,66]. Following this period, a progressive decline in the number of CD4+ cells occurs, exposing patients to opportunistic infections and cancers. CD4+ cell death can result from a direct viral cytotoxicity or from a CD8+ T lymphocyte-mediated killing of infected cells. However, AIDS, affecting 37.9 million of people worldwide [World Health Organisation (WHO) 2018] [67], can also be characterised by autoimmunity. Autoimmune disorders reported during HIV infection include arthralgia or arthritis, enlargement of the salivary glands (better known as diffuse infiltrative lymphocytosis syndrome, or DILS), sarcoidosis, Raynaud’s phenomenon, pulmonary hypertension, vasculitis and polymyositis [68]. Autoimmunity has been reported at different rates in HIV-infected patients according to ethnic provenience and therapies. Also, prevalence studies of SLE-affected cohorts with and without HIV infection are missing and direct comparisons biased by confounding factors, like age, gender, ethnicity and concomitant medications. Taking that worldwide SLE prevalence varies from ∼5 to 241/100 000 people [2], in a study on a prospective SLE cohort of 602 individuals, only 1.59% received an AIDS diagnosis; among them, many cases of neuroSLE were described [69].