[Reactive arthritis in HIV-infected patients: immunopathogenic aspects].
Reactive arthritis ReA is still an incompletely understood rheumatic disorder whose immunopathogeny involves several mechanisms. There is an association with Class-I histocompatibility antigens HLA-B27 and history of previous gastrointestinal or genitourinary infections. The molecular mimicry between bacterial and self antigens suggests the possibility of cross reactivity as a disease mechanism. The infection pandemics by the human immunodeficiency virus HIV changed the profile of the occurrence of a number of rheumatic diseases including ReA which appears to be more frequent more severe and refractory to the usual treatment for retrovirus-infected patients. The intensity of articular and extra-articular manifestations of ReA often makes the use of immunosuppressant drugs in these patients necessary. Due to the immunosuppression resulting from the retrovirosis itself the treatment becomes a dilemma for rheumatologists. HIV seems to play a role in the main ReA immunopathogenesis mechanisms either acting as direct arthritogenic agent or causing an immune dysfunction in the CD4 T lymphocytes T CD8 relationship leading to the deregulation in the production of cytokines or in advanced immunosuppression stages predisposing to infection by other arthritogenic pathogens. The use of highly active anti-retroviral therapy HAART has changed the profile of rheumatic events and the immunopathogeny of the HIV ReA association. The understanding of the basic ReA immunopathogenic mechanisms in HIV-infected patients is vital in the attempt of elucidating many still existing questions.
Serviço de Reumatologia do Hospital Universitário de Brasília--Universidade de Brasília (UnB). licia@unb.br
Licia Maria
LM
Henrique da Mota
Jamille Nascimento
JN
Carneiro
Rodrigo Aires Corrêa
RA
Lima
Leopoldo Luiz
LL
dos Santos Neto
Francisco Aires Corrêa
FA
Lima
D016918:Arthritis, Reactive / Q000209:etiology* / Q000276:immunology; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D000091402:Prohibitins
Artrite reactiva em pacientes infectados pelo HIV: aspectos imunopatogênicos.