Coexistence of HIV Infection and SLE: A Case Report
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Abstract
The co-existence of SLE and AIDS has been rarely reported. When the patient with SLE is complicated by HIV infection, the clinical manifestation will be modified to be milder degree. Our case was a 44-year old woman who was definitely diagnosed as SLE, depending on the combination of polyarthritis, autoimmune hemolytic anemia (AIHA), painless oral ulcer, repeated lymphopenia and positive ANA antibody. The corticosteroid could induce all clinical manifestations into the remission and it could be tapered and stopped within six months. She had been clinically in remission without drug for one and a half years until she was urgently admitted because of E. coli septicemia due to the upper urinary tract infection and Pneumocystis carinii pneumonia concomitantly with the recurrence of AIHA. The HIV antigen/antibody was positive while the CD4 count was 251/mm3. She again responded well to steroid and the appropriate antibiotics. Within 8 months, her CD4 count was gradually lowered to be 147/mm3 and the viral load was 32,800 copies/ml. The antiretroviral therapy was started and continued until 7 months, the polyarthralgia recurred whereas the CD4 level was raised to 225/mm3. But it could be easily controlled by only NSAIDs. In general, the natural course of SLE is to remit and to relapse but our case could be in remission for a long time without steroid therapy, presumably due to HIV infection and it recurred after the CD4 count was increased following antiretroviral therapy.
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