Prevalence of cryoglobulinemia and serological markers of autoimmunity in human immunodeficiency virus infected individuals: a cross-sectional study of 97 patients.
OBJECTIVE
Autommune diseases could constitute one emerging cause of morbidity in patients infected with human immunodeficiency virus (HIV) due to the chronicity of the infection and to the high level of B cell stimulation induced by HIV. We conducted a cross-sectional study investigating the clinical and biological signs of autoimmunity in HIV infected patients.


METHODS
We studied the following plasma immunological variables: antinuclear antibodies (ANA) and antibodies to extractable nuclear antigens, antiphospholipids, anticardiolipins (aCL), antineutrophil cytoplasmic antibodies (ANCA), rheumatoid factor (RF), cryoglobulinemia, total complement, and C4 factor. HIV-RNA, CD4+ cell count, and serological status for hepatitis B (HBV) and C virus (HCV) were also studied. Clinical signs of autoimmune diseases were noted.


RESULTS
In total, 97 patients were investigated (men 74%). Median age was 38 years (range 20-64). Median CD4+ count and HIV-RNA were 333/mm3 and 1662 copies/ml, respectively. Coinfection by HBV and HCV was present in 7% and 64% of the patients. In patients with HIV only, we detected cryoglobulinemia in 17% of patients, a positive RF in 19%, ANA > 1/100 in 21%, aCL in 51%, and ANCA > 1/20 in 17% (most of them type C by ELISA). There was a trend for a higher level of cryoglobulinemia and aCL in patients having CD4 lymphocyte counts > 350/mm3 than in others (25% vs 11%, p = 0.26, and 63% vs 42%, p = 0.23, respectively). Patients coinfected with HCV had a higher prevalence of cryoglobulinemia than HCV-free patients (42% vs 17%; p = 0.01). Prevalence of other immunological abnormalities was not different between patients with HIV only and HCV coinfected patients. Thirty patients expressed at least one clinical sign compatible with autoimmune disease. Patients with cryoglobulinemia more often had coinfection with HCV (OR 6.64, 95% CI 1.87-23.57) and IgM > 1.9 g/l (OR 6.16, 95% CI 2.15-17.67).


CONCLUSIONS
Humoral immunological abnormalities are frequent in patients with HIV, but are rarely associated with severe clinical signs.
Bonnet
Fabrice
F
Service de Médecine Interne et Maladies Infectieuses, Hôpital Saint-André, 1 rue Jean Burguet, 33075 Bordeaux cedex, France.
Pineau
Jean-Jacques
JJ
Taupin
Jean-Luc
JL
Feyler
Anne
A
Bonarek
Mojgan
M
de Witte
Sten
S
Bernard
Noelle
N
Lacoste
Denis
D
Morlat
Philippe
P
Beylot
Jacques
J
D000328:Adult; D017677:Age Distribution; D000704:Analysis of Variance; D015551:Autoimmunity / Q000276:immunology* / Q000502:physiology; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003449:Cryoglobulinemia / Q000453:epidemiology* / Q000276:immunology*; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology*; D016174:Hepacivirus / Q000276:immunology*; D006526:Hepatitis C / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011336:Probability; D012680:Sensitivity and Specificity; D012698:Serologic Tests; D012720:Severity of Illness Index; D017678:Sex Distribution; D018709:Statistics, Nonparametric
D015415:Biomarkers