title: HIV/AIDS and rheumatoid arthritis.
abstract: The acquired immunodeficiency syndrome (AIDS) is an infectious disease caused by the human immunodeficiency virus (HIV). It was first recognized in the United States in 1981, and the HIV/AIDS epidemic has since spread to affect all countries. The interface of HIV/AIDS with opportunistic infectious diseases is well characterized, but further research is required into the concurrence of other chronic diseases. The objective of this review was to identify possible interferences of HIV infection in the diagnosis and management of rheumatoid arthritis (RA). A review of the available evidence was conducted using the GRADE approach. Overall, the quality of evidence was low. Our main conclusions were: (1) the occurrence of rheumatoid-like arthritis in patients with HIV/AIDS is quite rare; therefore, it is not recommended that HIV infection be considered routinely as a differential diagnosis in this condition (C2); (2) HIV infection may lead to rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) antibody positivity, but usually at low titers (C1); (3) RA might cause false-positive HIV serology and ELISA seems to be a more specific test for HIV in patients with RA (C2); (4) RA and AIDS may coexist, even in cases of severe immunosuppression (C1); (5) RA emergence may seldom occur during or after immune reconstitution (C1); and (6) there is insufficient safety data to recommend use of specific disease-modifying antirheumatic drugs (DMARDs) in RA patients with HIV/AIDS. Therefore, these drugs should be used cautiously (C1).
authors.affiliation: Universidade de Brasília (UnB), Brasília, DF, Brazil. Electronic address: bmcunha@sarah.br.
authors.forename: Bernardo M
authors.initials: BM
authors.lastname: Cunha
authors.affiliation: Universidade de Brasília (UnB), Brasília, DF, Brazil. Electronic address: liciamariamhmota@gmail.com.
authors.forename: Licia Maria H
authors.initials: LM
authors.lastname: Mota
authors.affiliation: Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP), São Paulo, SP, Brazil. Electronic address: gecilmara@gmail.com.
authors.forename: Gecilmara S
authors.initials: GS
authors.lastname: Pileggi
authors.affiliation: Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brazil. Electronic address: izabellasafe@gmail.com.
authors.forename: Izabella P
authors.initials: IP
authors.lastname: Safe
authors.affiliation: Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brazil. Electronic address: marcuslacerda.br@gmail.com.
authors.forename: Marcus V G
authors.initials: MV
authors.lastname: Lacerda
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000188:drug therapy* / Q000276:immunology; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D012074:Remission Induction; D012217:Rheumatoid Factor / Q000276:immunology
chemical_list: D018501:Antirheumatic Agents; D012217:Rheumatoid Factor
keywords: AIDS; Disease-modifying antirheumatic drugs; HIV; Rheumatoid arthritis; Rheumatoid factor