The Rheumatologist
COVID-19 News
  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed
  • Home
  • Conditions
    • Rheumatoid Arthritis
    • SLE (Lupus)
    • Crystal Arthritis
      • Gout Resource Center
    • Spondyloarthritis
    • Osteoarthritis
    • Soft Tissue Pain
    • Scleroderma
    • Vasculitis
    • Systemic Inflammatory Syndromes
    • Guidelines
  • Resource Centers
    • Axial Spondyloarthritis Resource Center
    • Gout Resource Center
    • Psoriatic Arthritis Resource Center
    • Rheumatoid Arthritis Resource Center
    • Systemic Lupus Erythematosus Resource Center
  • Drug Updates
    • Biologics & Biosimilars
    • DMARDs & Immunosuppressives
    • Topical Drugs
    • Analgesics
    • Safety
    • Pharma Co. News
  • Professional Topics
    • Ethics
    • Legal
    • Legislation & Advocacy
    • Career Development
      • Certification
      • Education & Training
    • Awards
    • Profiles
    • President’s Perspective
    • Rheuminations
    • Interprofessional Perspective
  • Practice Management
    • Billing/Coding
    • Quality Assurance/Improvement
    • Workforce
    • Facility
    • Patient Perspective
    • Electronic Health Records
    • Apps
    • Information Technology
    • From the College
    • Multimedia
      • Audio
      • Video
  • Resources
    • Issue Archives
    • ACR Convergence
      • Systemic Lupus Erythematosus Resource Center
      • Rheumatoid Arthritis Resource Center
      • Gout Resource Center
      • Abstracts
      • Meeting Reports
      • ACR Convergence Home
    • American College of Rheumatology
    • ACR ExamRheum
    • Research Reviews
    • ACR Journals
      • Arthritis & Rheumatology
      • Arthritis Care & Research
      • ACR Open Rheumatology
    • Rheumatology Image Library
    • Treatment Guidelines
    • Rheumatology Research Foundation
    • Events
  • About Us
    • Mission/Vision
    • Meet the Authors
    • Meet the Editors
    • Contribute to The Rheumatologist
    • Subscription
    • Contact
  • Advertise
  • Search
You are here: Home / Articles / HIV Infection: What Rheumatologists Need to Know

HIV Infection: What Rheumatologists Need to Know

June 15, 2015 • By Leonard H. Calabrese, DO, & Elizabeth Kirchner, MSN, CNP

  • Tweet
  • Email
Print-Friendly Version / Save PDF
Although HIV testing may seem outside our scope of practice as rheumatologists, it’s important to consider incorporating it into your screening procedures, along with tests for hepatitis B and C.

Although HIV testing may seem outside our scope of practice as rheumatologists, it’s important to consider incorporating it into your screening procedures, along with tests for hepatitis B and C.
Image Credit: Africa Studio/SHUTTERSTOCK.COM

It has been nearly 35 years since the original descriptions of what now is recognized as AIDS (the acquired immune deficiency syndrome), an advanced form of infection secondary to the human immunodeficiency virus (HIV). The epidemic of HIV infection remains the singular most dramatic epidemic of our generation and will likely remain with us for generations to come.

You Might Also Like
  • Rheumatologists Treating Patients with HIV Face Treatment, Diagnostic Challenges
  • Infection Rates for Patients with SLE on Immunosuppressive Drugs
  • History of Infection Linked to Primary Sjögren’s Syndrome
Explore This Issue
June 2015

The disease itself (i.e., HIV infection) has been transformed from a highly fatal illness with a progressive course and no known therapy to a complex but manageable disease for those with access to antiviral therapy. Socially, the epidemic of HIV infection has changed from one of high visibility attended by fear and stigmatization to one that now has lost much of its exclusivity, affecting all segments of the population to some degree, albeit disproportionally.

ad goes here:advert-1
ADVERTISEMENT
SCROLL TO CONTINUE

Management of HIV infection requires the participation of virtually all specialists to attend to its complications and comorbidities. An important question for the rheumatology community is: What is our current role and responsibility in caring for the nearly 1 million infected patients living today, some of whom will need our services in the years to come?

Our review approaches this question in three parts. The first section reviews the transformation of HIV infection from a devastating immunodeficiency to a chronic inflammatory disease with remarkable symmetry to several connective tissue diseases. The second discusses the dramatic deceleration of HIV-associated autoinflammatory manifestations and the emergence of a new set of rheumatic morbidities. The final section focuses on four areas that we believe rheumatologists and advanced practitioners in rheumatology need to be aware of to be in a position to provide optimal care.

ad goes here:advert-2
ADVERTISEMENT
SCROLL TO CONTINUE

From Immunodeficiency to Chronic Inflammatory Disease

On June 5, 1981, an account appeared in the Morbidity and Mortality Weekly Report describing five men from the Los Angeles area with a previously undescribed immunodeficiency. This marked the recorded beginning of the AIDS epidemic. Many clinicians and researchers suspected that AIDS had an infectious etiology, but it took until 1983 for the discovery of the virus.1

In retrospect, we can now view this epidemic as having three phases, beginning with its presentation as a devastating immunodeficiency in which individuals, often homosexual men or intravenous drug users, developed serious and multiple opportunistic infections. These infections were often treatable, such as pneumocystis pneumonia (caused by p. jirovecii, formerly known as p. carinii), serious mycobacterial and fungal infections, as well as opportunistic malignancies, such as Kaposi’s sarcoma (KS). Such a constellation had not been previously described in otherwise healthy individuals, and this phase, lasting roughly through the end of the first decade of AIDS, could be considered the era of morbidity and mortality due to treatable opportunistic infections.

One striking area of clinical similarity between HIV infection and RA is the aaccelerated cardiovascular disease.

A second recognizable phase of the epidemic evolved when both diagnosis and management had greatly improved to the point at which patients were recognized earlier and afforded antimicrobial prophylaxis for many of these opportunistic infections (e.g., SMZ-TMP to prevent PJP). During this phase, which may be viewed as the era of morbidity and mortality due to untreatable opportunistic complications, patients succumbed to those complications having either no effective therapy, such as progressive KS and progressive multifocal leukoencephalopathy, or profoundly challenging infections to treat, such as disseminated CMV and other pathogens. Without effective antiviral therapy, which at the time was limited to only a few drugs, the prognosis for the infected population was grim, and by 1993, AIDS was the leading cause of death among people age 25–44.1

ad goes here:advert-3
ADVERTISEMENT
SCROLL TO CONTINUE

Pages: 1 2 3 4 5 6 | Single Page

Filed Under: Conditions, Practice Management Tagged With: AIDS, HIV, Infection, patient care, Rheumatoid arthritis, rheumatologistIssue: June 2015

You Might Also Like:
  • Rheumatologists Treating Patients with HIV Face Treatment, Diagnostic Challenges
  • Infection Rates for Patients with SLE on Immunosuppressive Drugs
  • History of Infection Linked to Primary Sjögren’s Syndrome
  • Rheumatoid Arthritis Patients on Biologics Remain At Risk of Infection

Meeting Abstracts

Browse and search abstracts from the ACR Convergence and ACR/ARP Annual Meetings going back to 2012.

Visit the Abstracts site »

Rheumatology Research Foundation

The Foundation is the largest private funding source for rheumatology research and training in the U.S.

Learn more »

American College of Rheumatology

Visit the official website for the American College of Rheumatology.

Visit the ACR »

The Rheumatologist newsmagazine reports on issues and trends in the management and treatment of rheumatic diseases. The Rheumatologist reaches 11,500 rheumatologists, internists, orthopedic surgeons, nurse practitioners, physician assistants, nurses, and other healthcare professionals who practice, research, or teach in the field of rheumatology.

About Us / Contact Us / Advertise / Privacy Policy / Terms of Use

  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed

Copyright © 2006–2022 American College of Rheumatology. All rights reserved.

ISSN 1931-3268 (print)
ISSN 1931-3209 (online)

loading Cancel
Post was not sent - check your email addresses!
Email check failed, please try again
Sorry, your blog cannot share posts by email.