HIV-Associated Systemic Sclerosis: Literature Review and a Rare Case Report
Abstract
:1. Introduction
2. Case Report
3. Discussion
4. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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S. No. | Investigation | Results |
---|---|---|
1. | HIV Status | |
HIV Serology | HIV-1 + ve (retro + ve since 2012) TLE regimen of ART | |
CD4 cell count | 440 cells/mm3 | |
HIV viral load | 2,214,173 copies/mL | |
2. | Complete Blood Count (CBC) | |
Hemoglobin (Hb) | 6.8 g/dL | |
Total leucocyte count (TLC) | 4490 cells/μL | |
Platelets | 1.3 lakh platelets/μL | |
Erythrocyte sedimentation rate (ESR) | 85 mm/hr | |
Bleeding time (BT) | 80 s | |
Clotting time (CT) | 42 s | |
International normalized ratio (INR) | 1.5 | |
3. | Liver function test (LFT) | |
Albumin | 2.3 g/dL | |
Globulin | 1.0 g/dL | |
Bilirubin | 2.6 mg/dL | |
Alanine transaminase (ALT) | 71 units/L serum | |
Aspartate aminotransferase (AST) | 33 units/L serum | |
Alkaline phosphatase (ALP) | 672 IU/L | |
Hepatitis B surface antigen (HBs Ag) | −ve | |
Anti HCV antibody | −ve | |
α-Feto protein (AFP) | 34 ng/mL | |
4. | Kidney function test (KFT) | |
Na+/K+ | 141/4.1 mEq/L | |
Urea | 21 mg/dL | |
Creatinine | 0.4 mg/dL | |
Urine (R/M) | Normal range | |
5. | Immunologic profile | |
Antinuclear Antibodies (ANA) | 1:1000 (Intensity 4+) | |
Extractable Nuclear Antigens (ENA) profile (ELISA) | ||
Anti ds-DNA autoantibody | −ve | |
Ro (SSA) and La (SSB) autoantibody | −ve | |
Anti Smantibodies | −ve | |
Auto-RNP Ab | −ve | |
Anti Scl-70- Ab | +ve (32.96 units/mL) | |
Anti-mitrochondrial Ab (AMA) | +ve (suggestive of autoimmune hepatitis) | |
Anti smooth muscle Ab (ASMA) | +ve (suggestive of autoimmune hepatitis) | |
Anti cyclic citrullinated peptide (Anti-CCP) | −ve | |
Anti cerulopasmin Ab | −ve | |
6. | Radiographic investigations | |
USG Abdomen | Mild coarse liver echotexture with surface nodularity, mild ascites | |
Magnetic resonance cholangiopancreatography (MRCP) | Gall bladder cholestasis; hepatomegaly with chronic liver disease; splenomegaly with pulmonary hypertension; bilateral single renal cortical cyst; normal common bile duct (CBD); right and left hepatic ducts and intrahepatic bile duct | |
High-resolution computed tomography (HRCT) | Ground glass opacity with peripheral and sub-pleural distribution suggestive of early stage interstitial lung disease | |
7. | Liver Biopsy | Revealed liver cirrhosis with activity compatible with autoimmune hepatitis |
8. | Current Treatment Regimen | |
Table Methotrexate | 15 mg weekly | |
Table Folvite | 5 mg weekly | |
Table Omnacortical | 5 mg OD | |
Table Hydroquinone (HCQ) | 200 mg OD HS | |
Table Calcitin-D | 500 mg BD | |
Table Autrin | 10 mg OD | |
Table Etoricoxib | 90 mg OD HS | |
Table Pantop | 40 mg OD |
S. No | Author(s) and Year | Age/Sex | HIV Status | Systemic Sclerosis Features | Other Associated Ailments |
---|---|---|---|---|---|
1. | Sikdar et al., 2005 [18] Simultaneous diagnosis of HIV and SSc | 45/F | CD4+ lymphocyte count increase observed after 6 months HAART. | The patient developed symptoms of SSc in the background of immune suppression and responded well to steroids and HAART therapy | - |
2. | Mosquera JA, et al., 2010 [17] | 44/M | HIV +ve, CD4 cell count = 934 cells/mm3, viral load < 40 copies/mL | Tumification of forearms, thighs, and legs; Raynaud’s phenomena +ve; skin biopsy revealed scleroderma features | +ve HCV serology |
3. | Mosquera JA, et al., 2010 [17] | 42/M | Stage II HIV infection | Skin thickening with spasticity in legs; skin biopsy revealed SSc features | +ve HCV and HBV serology; type II diabetes mellitus |
4. | Okongo LO, et al., 2014 [5] | 9/F | Perinatally acquired HIV; on ART therapy; CD4 cell count = 879 cells/mm3; lower than detectable viral load | Raynaud’s phenomena +ve with fingertip ulceration and digital ischemia; thickened extremities and torso skin; B/L sclerodactyly with limited extension and flexion of fingers | Completed TB therapy at 6 months |
5. | Dembelae IA et al., 2018 [16] Concomitant diagnosis of HIV and systemic sclerosis. | 56/F | HIV stage III | Sclerodactyly; +ve Raynaud’s phenomena; +ve anti Scl-70 Abs | +ve HBV serology |
6. | Yao Q, et al., 2008 [24] Retrospective study; out of 888 HIV diagnosed cases, only 1 case of SSc was seen | 45/F | HIV +ve (acquired from heterosexual partner) | Progressive stiffening of face and extremities skin, mask-like face | Renal insufficiency |
7. | Yen et al., 2016 [25] Only 4 cases of SSc out of 20,444 HIV cases | 3 males and 1 female | 1 patient on HAART and 3 patients without HAART | - | - |
Author (s) and Year | Autoantigen | Viral Antigen |
---|---|---|
Douvas et al., 1996 [28] | U1 RNP 70 kD; seen in MCTD and SSc | HIV gp120/41 envelope complex |
Query CC et al., 1987 [29] | U1 RNP 70 kD; seen in MCTD and SSc | Retroviral p30 gag protein |
Maul GG et al., 1989 [30] | DNA Topoisomerase I 110 kD; seen in diffuse SSc | Retroviral p30 gag protein |
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Hasan, S.; Aqil, M.; Panigrahi, R. HIV-Associated Systemic Sclerosis: Literature Review and a Rare Case Report. Int. J. Environ. Res. Public Health 2022, 19, 10066. https://doi.org/10.3390/ijerph191610066
Hasan S, Aqil M, Panigrahi R. HIV-Associated Systemic Sclerosis: Literature Review and a Rare Case Report. International Journal of Environmental Research and Public Health. 2022; 19(16):10066. https://doi.org/10.3390/ijerph191610066
Chicago/Turabian StyleHasan, Shamimul, Mohd. Aqil, and Rajat Panigrahi. 2022. "HIV-Associated Systemic Sclerosis: Literature Review and a Rare Case Report" International Journal of Environmental Research and Public Health 19, no. 16: 10066. https://doi.org/10.3390/ijerph191610066