Lessons from similarities between SLE and HIV infection

Autoantibodies Among HIV-1 Infected Individuals and the Effect of Anti-Retroviral Therapy (ART) on It

BACKGROUND

Antiretroviral therapy (ART) has led to a decline in autoimmune diseases but lacks studies on its effect on autoantibodies.

METHODS

It is a cross-sectional study with archived samples from 100 paired HIV-1 infected ART naïve and experienced individuals and 100 prospectively collected matched blood-donor controls. Antinuclear antibody, IgG anticardiolipin antibody, IgM and IgG β2 glycoprotein-1 antibodies, and total IgG levels were detected. Results are expressed as mean with standard deviation (SD), median, percentage positivity, and a p<0.05 is considered significant. The study was approved by the Institutional Review Board.

RESULTS

The median viral load of the treatment naïve samples was 4.34 Log copies/mL, while all were virally suppressed post ART with a median duration of treatment for 12 months (range: 3-36 months). The percentage of antinuclear antibody positivity was 5% among ART naïve and controls, with a decrease of 2% post ART (p= 0.441). The positivity for anti-cardiolipin antibody was 15% among ART naïve while none of the ART experienced or controls were positive (p<0.05). IgM β2 glycoprotein-1 were 4%, 1% and 3% among ART naïve, treated and controls, respectively (p<0.05). IgG β2 glycoprotein-1 was 2% among ART naïve while none of the treated and controls were positive (p<0.05). The mean total IgG level among ART naïve, experienced, and controls were 21.82 (SD 6.67), 16.91 (SD 3.38), 13.70 (SD 2.24) grams/Litre, respectively (p<0.05).

CONCLUSION

ART has a significant effect on IgG anti-cardiolipin antibody and total IgG but only a marginal effect on ANA, IgM, and IgG β2 glycoprotein-1 antibodies.

Clinical and Laboratory Characteristics of Herpes Zoster in Patients With HIV/AIDS and Those With Juvenile Systemic Lupus Erythematosus

BACKGROUND

HIV infection and juvenile systemic lupus erythematosus (jSLE) are risk factors for the development of herpes zoster (HZ) and its complications. Both diseases share similar immunologic aspects, such as immunodeficiency and immune activation. Therefore, our objective was to evaluate and compare the frequency and characteristics of HZ episodes in pediatric patients with HIV infection and jSLE.

METHODS

A retrospective cohort study was carried out with the evaluation of 2 pediatric cohorts: HIV patients who were followed from January 1987 to December 2014 and patients with jSLE followed up from January 1990 to December 2014 in outpatient clinics.

RESULTS

Of the 190 HIV patients, 48 had HZ (25.3%), with 67 episodes; of the 92 patients with jSLE, 27 had HZ (29.3%), totaling 28 episodes. The median age at the first episode of HZ was higher in the jSLE than in the HIV group (8.9 vs. 12.5 years, respectively) (P = 0.020). HIV patients were more likely to have recurrent HZ (P = 0.025). In addition, there was a tendency for HIV patients to present with disseminated HZ more frequently (P = 0.060). Although the hospitalization rate was similar between groups, patients with jSLE received intravenous acyclovir more frequently (P = 0.014). When HIV non-immune reconstitution syndrome patients were compared with jSLE group, recurrence of HZ in HIV was the only significant difference between groups (P = 0.017).

CONCLUSIONS

Patients with HIV had more recurrent HZ than patients with jSLE.

Longitudinal Analysis Reveals Early Development of Three MPER-Directed Neutralizing Antibody Lineages from an HIV-1-Infected Individual

Lineage-based vaccine design is an attractive approach for eliciting broadly neutralizing antibodies (bNAbs) against HIV-1. However, most bNAb lineages studied to date have features indicative of unusual recombination and/or development. From an individual in the prospective RV217 cohort, we identified three lineages of bNAbs targeting the membrane-proximal external region (MPER) of the HIV-1 envelope. Antibodies RV217-VRC42.01, -VRC43.01, and -VRC46.01 used distinct modes of recognition and neutralized 96%, 62%, and 30%, respectively, of a 208-strain virus panel. All three lineages had modest levels of somatic hypermutation and normal antibody-loop lengths and were initiated by the founder virus MPER. The broadest lineage, VRC42, was similar to the known bNAb 4E10. A multimeric immunogen based on the founder MPER activated B cells bearing the unmutated common ancestor of VRC42, with modest maturation of early VRC42 intermediates imparting neutralization breadth. These features suggest that VRC42 may be a promising template for lineage-based vaccine design.

Sera of patients with systemic lupus erythematosus cross-neutralizes dengue viruses

Dengue is the most prevalent mosquito-borne disease in Southeast Asia, where the incidence of systemic lupus erythematosus (SLE) is approximately 30 to 53 per 100,000. Severe dengue, however, is rarely reported among individuals with SLE. Here, whether sera of patients with SLE cross-neutralize dengue virus (DENV) was investigated. Serum samples were obtained from individuals with SLE who were dengue IgG and IgM serology negative. Neutralization assays were performed against the three major DENV serotypes. Of the dengue serology negative sera of individuals with SLE, 60%, 61% and 52% of the sera at 1/320 dilution showed more than 50% inhibition against dengue type-1 virus (DENV-1), DENV-2 and DENV-3, respectively. The neutralizing capacity of the sera was significantly greater against DENV-1 (P < 0.001) and DENV-3 (P < 0.01) than against DENV-2 (P < 0.05). Neutralization against the DENV correlated with dengue-specific IgG serum titers below the cut-off point for dengue positivity. Depletion of total IgG from the sera of patients with SLE resulted in significant decreases of up to 80% in DENV inhibition, suggesting that IgG plays an important role. However, some of the SLE sera was still able to neutralize DENV, even with IgG titers <0.1 OD absorbance. Our findings suggest that sera of patients with SLE contain IgG, and possibly other type of antibodies, that can cross-neutralize DENV, which may explain the rarity of severe dengue in individuals with SLE. Further studies, are needed to further substantiate this finding and to elucidate the specific neutralizing epitopes recognized by the sera of individuals with SLE.

Targeting human immunodeficiency virus type 1 with antibodies derived from patients with connective tissue disease

During the budding process, human immunodeficiency virus (HIV) acquires several cellular proteins from the host. Thus, antibodies against self antigens found in sera patients with autoimmune disorders may cross react with host-derived or the HIV-specific proteins gp120 and gp41 on the viral envelope and probably neutralize HIV infection. To verify this hypothesis, 88 sera from HIV negative patients suffering from systemic lupus erythematosus (SLE) and other autoimmune disorders were analysed for cross reacting antibodies against HIV-1 by Western blot and FACS analysis indicating that antibodies cross-react with epitopes expressed on HIV infected or non-infected cells. Virus capture assays revealed that HIV-1IIIBwas directly recognized by 60% of sera from patients with autoimmune disorders. Sera were also tested in HIV neutralization assays with stimulated T cells. Reduction of the viral load by patient sera correlated with their reactivity in Western blot analysis. Complement further enhanced the reduction of viral titres, although no complement-mediated lysis was observed. These data suggest a possible protective role of auto-antibodies against HIV infection in lupus patients.

Pseudo-SLE by human immunodeficiency virus infection

A 61-year-old woman was admitted for long-lasting fever and recurrent opportunistic infections during the treatment of SLE. She had been diagnosed as SLE and type-IV nephritis based on a renal biopsy and serological findings. A colonoscopy and liver biopsy revealed disseminated Mycobacterium avium complex infection. Human immunodeficiency virus (HIV) infection status was then examined and found to be positive. From the clinical course, the first symptoms were inferred to have been those of HIV infection.

Increased Incidence of juvenile onset systemic lupus erythematosus in children with atopic dermatitis

Herein, we investigated the risk of juvenile-onset systemic lupus erythematosus (JSLE) in children with atopic dermatitis (AD). From 2000 to 2007, 192,357 children with newly diagnosed AD and 769,428 matched non-AD controls were identified. By the end of 2008, incidences and hazard ratios (HRs) of JSLE were measured. JSLE incidence in the AD cohort was 2.90-fold greater than that in the non-AD cohort (3.25 vs. 1.12 per 100,000 person-years), with a Cox model-measured adjusted HR of 2.92 (95% CI: 1.85-4.60); the risk of JSLE was greater for older children and girls. The AD-to-non-AD cohort HR was 6.6 (95% CI: 2.88-13.1) for children aged >12 years compared with 1.81 (95% CI: 0.98-3.32) for children aged ≤ 12 years. The HR of JSLE in AD children increased from 1.55 (95% CI: 0.88-2.76) for those with ≤ 3 clinical visits to 66.3 (95% CI: 33.1-132.8) for those with >6 visits (p < 0.0001, by trend test). The risk of developing SLE in the AD cohort was the highest within five years after AD diagnosis (HR: 4.02; 95% CI: 2.83-7.08). Children with AD are at a high risk of developing JSLE during their growth period.

Increased incidence of juvenile-onset systemic lupus erythematosus among children with asthma

BACKGROUND

Children with systemic lupus erythematosus (SLE) have an especially aggressive disease course and poor outcomes. Previous studies demonstrated a possible association between SLE and allergies, but the relationship between these disorders remains unclear. This population-based cohort study aimed to investigate the incidence and risk of juvenile-onset SLE (JSLE) among children with asthma.

METHODS

From 2000 to 2003, 120,939 children with newly diagnosed asthma and 483,756 randomly selected non-asthma controls were enrolled. We used a multivariable Cox proportional hazard regression model to measure and compare the incidence rate and risk of JSLE in the asthma and non-asthma cohorts.

RESULTS

The overall incidence of JSLE was 2.52 times greater in the asthma cohort than that in the non-asthma cohort [3.49 vs. 1.53 per 100,000 person-years; 95% confidence interval (CI): 1.59-3.99]. The risk of JSLE was greatest among boys [hazard ratio (HR) 3.02, 95% CI: 1.21-7.52] and children aged 6-10 yr (HR 3.50, 95% CI: 1.75-7.02). The HR of JSLE increased with greater frequency of asthma-related medical visits from 1.22 (95% CI: 0.67-1.41) for those with ≤2 visits/yr to 5.88 (95% CI: 3.43-10.1) for subjects with >2 visits/yr (trend test p < 0.001). However, the risk of JSLE declined over time.

CONCLUSION

We found an increased incidence of JSLE among children with asthma. The mechanism of asthma on JSLE development should be elucidated to establish innovative disease intervention programs.

Aplastic anemia associated to systemic lupus erythematosus in an AIDS patient: a case report

Aplastic anemia is a bone marrow failure syndrome characterized by peripheral cytopenias and hypocellular bone marrow. Although aplastic anemia is idiopathic in most cases, rheumatic diseases such as systemic lupus erythematosus are recognized as causes of aplastic anemia, with their possible etiological mechanisms being T and B lymphocyte dysfunction and pro-inflammatory cytokines and autoantibody production directed against bone marrow components. In the course of the human immunodeficiency virus infection/acquired immunodeficiency syndrome, the identification of autoantibodies and the occurrence of rheumatic events, in addition to the natural course of systemic lupus erythematosus which is modified by immune changes that are characteristic of human immunodeficiency virus infection/acquired immunodeficiency syndrome, make the diagnosis of systemic lupus erythematosus challenging. This study reports the case of a woman with acquired immunodeficiency syndrome treated with a highly active antiretroviral therapy, who had prolonged cytopenias and hypocellular bone marrow consistent with aplastic anemia. The clinical picture, high autoantibodies titers, and sustained remission of the patient's hematological status through immunosuppression supported the diagnosis of systemic lupus erythematosus-associated aplastic anemia. This is the first report of aplastic anemia concurrent with systemic lupus erythematosus and acquired immunodeficiency syndrome, providing additional evidence that immune dysfunction is a key part of the pathophysiological mechanism of aplastic anemia.

HIV and systemic lupus erythematosus: the clinical and diagnostic dilemmas of having dual diagnosis

We present the case of a young black African woman living in the UK who presented with systemic lupus erythematosus (SLE) and HIV. The reported coexistence of HIV and SLE is unusual with fewer than 30 published cases. We discuss some of the clinical and diagnostic challenges that face clinicians when a patient presents with both conditions. In particular, we discuss the overlap in symptoms, signs and laboratory findings, and the difficulties that this may pose in terms of making a diagnosis. The implications that having a dual diagnosis may have for treating each condition are also discussed. With increased HIV testing in a variety of clinical settings there is likely to be an increase in detection of similar cases. This case emphasizes the need for careful diagnostic testing and judicious interpretation of the validity of laboratory results in order to reach an accurate diagnosis in such patients.

Autoimmunity and HIV

PURPOSE OF REVIEW

This review focuses on some of the recent advances in the understanding of HIV immunopathogenesis and the diagnosis and treatment of several autoimmune conditions associated with HIV in the era of potent antiretroviral therapy.

RECENT FINDINGS

Chronic immune activation with progressive immune exhaustion are central features of HIV pathogenesis. The role of self-reactive T cells in the generation and maintenance of this process has recently been described. The understanding of the impact of immune dysregulation on the generation of autoimmune phenomena in HIV infection remains incomplete. The diagnosis of autoimmune diseases in the context of HIV is often difficult due to similarities in clinical presentations and laboratory markers. The antiretroviral therapy-associated immune reconstitution syndrome can present as autoimmune disease.

SUMMARY

The cause, frequency and prognosis of autoimmune conditions associated with HIV infection remain somewhat uncertain. Their management is often empirical with the use of novel immunosuppressive medication.

Type I interferon in HIV treatment: from antiviral drug to therapeutic target

Type I interferons (IFNs) are soluble molecules that exert potent antiviral activity and are currently used for the treatment of a panel of viral infections. In the case of HIV, the use of type I IFN has had limited success, and has almost been abandoned. During the last decade, a series of studies has highlighted how HIV infection may cause overactivation of type I IFN production, which contributes to the exhaustion of the immune system and to disease progression. This review describes the transition from the proposed use of type I IFN as antiviral drugs in HIV infection, to the idea that blocking their activity or production may provide an immunologic benefit of much greater importance than their antiviral activity.

The natural antibody repertoire of sharks and humans recognizes the potential universe of antigens

In ancestral sharks, a rapid emergence in the evolution of the immune system occurred, giving jawed-vertebrates the necessary components for the combinatorial immune response (CIR). To compare the natural antibody (NAb) repertoires of the most divergent vertebrates with the capacity to produce antibodies, we isolated NAbs to the same set of antigens by affinity chromatography from two species of Carcharhine sharks and from human polyclonal IgG and IgM antibody preparations. The activities of the affinity-purified anti-T-cell receptor (anti-TCR) NAbs were compared with those of monoclonal anti-TCR NAbs that were generated from a systemic lupus erythematosus patient. We report that sharks and humans, representing the evolutionary extremes of vertebrate species sharing the CIR, have NAbs to human TCRs, Igs, the human senescent cell antigen, and to numerous retroviral antigens, indicating that essential features of the combinatorial repertoire and the capacity to recognize the potential universe of antigens is shared among all jawed-vertebrates.

DNA methylation in systemic lupus erythematosus

Recent studies on epigenetics, including DNA methylation and its regulatory enzymes, seem likely to contribute to elucidation of the pathogenesis of autoimmune diseases such as systemic lupus erythematosus (SLE), although the relationship between DNA methylation and SLE has long been the subject of investigation. To obtain a deeper understanding of the role of DNA methylation in the induction of SLE, we reviewed the relationship between DNA methylation and SLE based on findings reported in the literature and our own data. Various studies, including ours, have indicated the possible importance of DNA methylation, especially hypomethylation, in the etiology of SLE. These epigenetic studies may give us clues towards elucidation of the pathogenesis of SLE and development of new therapeutic strategies for this disease.