Paucity of Sjogren-like syndrome in a cohort of HIV-1-positive patients in the HAART era. Part II

Academic Department of Pathophysiology, AIDS Unit, School of Medicine, National and Kapodistrian University of Athens, Greece.
Rheumatology (Impact Factor: 4.48). 11/2003; 42(10):1164-7. DOI: 10.1093/rheumatology/keg316
Source: PubMed


This study was performed in order to investigate the prevalence of Sjögren-like syndrome (SLS) in the highly active anti-retroviral therapy (HAART) era in a cohort of HIV-1-positive Greek patients.
One hundred and thirty-one unselected patients were screened by the validated European Union (EU) criteria for Sjögren's syndrome. Of the 31 who gave a positive EU-validated questionnaire, 17 consented to undergo minor salivary gland biopsy and other tests.
Only two patients had a positive salivary gland biopsy and both belonged to the non-compliant HAART group, whereas none of the compliant HAART patients had histological findings.
It is concluded that SLS, the prevalence of which in the pre-HAART era was 7.8%, has disappeared, possibly as a result of the protective action of HAART.

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Available from: George Panayiotakopoulos, Sep 22, 2014
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    • "There has been one small experimental study in 16 Sjogren’s syndrome (SJS) patients who were randomized to receive placebo or lamivudine, a reverse transcriptase inhibitor, usually harnessed as part of Highly-Active Antiretroviral Therapy (HAART) for HIV patients [41]. This experimental treatment was given on the basis of observations that the incidence of diffuse infiltrative lymphocytosis syndrome (DILS) has significantly reduced since HAART has been introduced [42]. DILS is an SJS-like illness that affects HIV-infected individuals. "
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    • "The condition usually manifests several years after HIV seroconversion and, besides the lymphocitic infiltration of salivary and lachrymal glands, is characterised by lymphocytic interstitial pneumonitis (31%), myositis (26%) and hepatitis (23%) [61]. DILS differs from pSS by the fact that the occurrence of extra-glandular involvement is more frequent, whilst the presence of autoantibodies and rheumatoid factor is observed in a lower number of patients In addition, the two conditions differ in the nature of infiltrating lymphocytes (CD4+ T cells in pSS, CD8+ T cells in DILS) and in the association with different HLA haplotypes [58-60]. "
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    • "A successful HAART reduces viral replication, viral load in the peripheral blood falls to undetectable levels, the number of CD4+ T lymphocytes increases, and finally reconstitution of the immune system occurs. In a follow-up study, the prevalence of HIV-1-related SS dropped from 8% in the pre-HAART era to 1.5% (2 out of 131 patients) after the introduction of HAART [33]. Similar data were reported in a study from the US, where the prevalence of DILS had dropped significantly in the post-HAART era [34]. "
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