Autoimmune diseases and HIV/AIDS

Diseases & disorders of the immune system

Diseases of the immune system are diverse and have many causes but often have common signs and symptoms such as fatigue, joint pain, swollen joints, low-grade fever, skin changes, and weight loss. Many factors can be associated with immune system diseases, disorders, and infections. These diseases can involve the cells, tissues, and organs of the immune system.

Autoimmune diseases and disorders

Recall that the goal of the immune system is to protect the body from foreign pathogens and prevent infectious diseases. The immune system normally can distinguish self from foreign. However, in autoimmune diseases, something goes wrong in the immune system—it begins to attack healthy self cells.

According to the National Institutes of Health website MedlinePlus (https://medlineplus.gov), there are more than 80 different autoimmune diseases. The common factor among all autoimmune diseases is that a person’s own immune system attacks healthy tissues. No matter what the symptoms are, the underlying cause of the disease is an immune system that is not working properly.

The cause of autoimmune diseases is a mystery. There are many theories about how the immune system becomes confused. The following is a brief list of suspected causes:

• A viral or bacterial infection that triggers the immune system to attack healthy cells
• Exposure over time to toxins (e.g., chemicals, pesticides, and food additives)
• A weakness in a person’s immune system brought on by stress, past infections, and hormone fluctuations
• An imbalance in the intestinal microbiome
• Existing allergies (another type of immune system overreaction)

Many scientists think that a combination of all these possible causes influences a person’s risk of developing an autoimmune disease. Autoimmune diseases are an area of intense scientific research because more people are being diagnosed with autoimmune conditions. Risk factors for being diagnosed with an autoimmune disease include female gender, especially between the ages of 15 and 45, and African, Hispanic, or Native American race.

Common autoimmune diseases

• Rheumatoid arthritis
• Inflammatory bowel disease (IBD)
• Systemic lupus erythematosus (SLE)
• Multiple sclerosis (MS)
• Type 1 diabetes mellitus
• Guillain-Barré syndrome
• Psoriasis
• Grave’s disease
• Myasthenia gravis
• Hashimoto’s thyroiditis

Autoimmune diseases vary in their signs and symptoms, depending on the cells or tissues affected in the body. Some common signs and symptoms seem to affect a number of different autoimmune conditions. They include skin changes (discolorations, rashes, or lesions), joint pain, fatigue/malaise, low-grade fever, and general ill-feeling. Commonly affected cells or tissues include joints, muscles, skin, blood vessels and red blood cells, connective tissue, and endocrine glands (i.e., thyroid, pancreas).

To diagnose an autoimmune condition, the provider takes a complete history and performs a thorough physical examination. Laboratory and diagnostic testing procedures vary depending on the patient’s signs and symptoms. For most suspected autoimmune conditions, some or all of the following laboratory tests may be ordered:

• Antinuclear antibody test (ANA): A blood test that looks for the presence of antibodies to the nucleus or the organelles of the nucleus. A serum sample is used for this type of test.
• Autoantibody test: A blood/serum test that looks for autoantibodies.
• Complete blood cell count (CBC): A blood test. Some Clinical Laboratory Improvement Amendments (CLIA)-waived tests are available.
• Comprehensive metabolic panel (CMP): A blood test. Some CLIA-waived tests are available.
• C-reactive protein (CRP): A blood test that measures CRP. CRP is elevated in people with inflammation. Some CLIA-waived tests are available.
• Erythrocyte sedimentation rate (ESR): A whole blood test. People with inflammation have elevated values. Some CLIA-waived tests are available.
• Urinalysis: Some CLIA-waived tests are available.

Imaging tests, such as joint and bone x-rays, magnetic resonance imaging (MRI), and ultrasound scans, in addition to tissue biopsies, may be ordered.

Treatments will vary depending on the signs and symptoms of the condition. However, common goals of treatment for most autoimmune conditions include diminishing the signs and symptoms of the condition and/or reducing their occurrence, controlling the autoimmune process, and maintaining the body’s ability to fight disease and infections.

Treatments may include physical therapy, blood transfusions (if the condition affects blood cells), a modified diet (to reduce inflammation and boost the immune system with nutrient-dense foods), stress reduction, adequate sleep, regular exercise, and smoking cessation.

Medications may include nonsteroidal anti-inflammatory drugs (NSAIDs) (e.g., ibuprofen), corticosteroids, supplementation to replace substances lacking in the body (examples include thyroid hormones, insulin, vitamin B12, and vitamin D), and immunosuppressive drugs to reduce the body’s immune response (examples include prednisone, cyclosporine [Neoral], and adalimumab [Humira]).

Some alternative therapies that may bring symptom relief include yoga, massage therapy, and relaxation therapy. Special diets may also be used to help reduce inflammation or remove specific types of proteins from the diet (e.g., gluten-free diet, grain-free diet, and the elimination of sugar and natural/artificial sweeteners).

Sjogren’s syndrome

Sjogren’s syndrome is an autoimmune disorder that affects the glands that make tears and saliva but can also damage other parts of the body, such as the following:

• Joints
• Lungs
• Thyroid
• Skin
• Kidneys
• Nerves
• Liver

The cause of Sjogren’s syndrome is unknown. Genetics play a part and can put some people at higher risk, but there is also a triggering mechanism, such as an infection with a particular virus or bacteria. Risk factors include being female, over the age of 40, or having a rheumatic disease like rheumatoid arthritis or systemic lupus erythematosus (SLE).

This disease can be difficult to diagnose as the signs and symptoms are similar to other diseases and can vary from patient to patient. Blood tests will likely be done to look at the levels of the different types of blood cells, presence of antibodies common to Sjogren’s syndrome, evidence of inflammatory conditions, and indications of the problems with the liver and kidneys. Eye tests will be done to measure the dryness of the eyes. A biopsy of the lip may be done to detect clusters of inflammatory cells.

There is no cure for Sjogren’s syndrome. Treatment is focused on managing the signs and symptoms. The dry eyes and dry mouth may be helped with over-the-counter eyedrops and sipping water more frequently. Some patients may need prescription medications. Patients should not smoke as this can irritate and dry out the mouth. Sugarless gum or citrus-flavored hard candies can stimulate saliva flow.

Systemic lupus erythematosus

SLE is another autoimmune disease that can attack many different body systems, including joints, skin, kidneys, blood cells, the brain, and the heart and lungs. SLE is more common in women, can occur at any age, and is more common in African Americans, Hispanics, and Asian Americans.

The cause of SLE is unknown, but, like Sjogren’s syndrome, genetics can play a part. Environmental factors seem to provide a trigger for SLE. Potential triggers include sunlight, infections, and certain medications.

The most common signs and symptoms include the following:

• Fatigue
• Dry eyes
• Fever
• Shortness of breath
• Joint pain, stiffness, and swelling
• Chest pain
• Skin lesions that appear or worsen with sun exposure
• Headaches, confusion, and memory loss
• Butterfly-shaped rash on the face that covers the cheeks and bridge of the nose; or rashes elsewhere
• Fingers and toes that turn white or blue when exposed to cold or stress

As with Sjogren’s syndrome, diagnosing SLE can be difficult. The signs and symptoms can change over time and overlap with many other disorders. Blood tests will likely include a complete blood count (CBC), an evaluation of the erythrocyte sedimentation rate, kidney and liver assessments, and an antinuclear antibody (ANA) test. A urinalysis is also done.

Treatment of SLE depends on the patient’s signs and symptoms. Medications that might be used include nonsteroidal anti-inflammatory drugs (NSAIDs), antimalarial drugs, corticosteroids, immunosuppressants, and biologics.

HIV/AIDS

Acquired immunodeficiency syndrome (AIDS) is a chronic condition caused by the human immunodeficiency virus (HIV). HIV attacks the immune system of its host and specifically damages the CD4+ T lymphocytes (helper T cells). HIV impairs the immune system’s ability to fight infectious agents that can cause disease.

Currently, HIV/AIDS can be treated but not cured; without proper and consistent treatment, it is a life-threatening disease. The treatment for HIV/AIDS that is available now slows the progression of the disease and allows a person to live a relatively normal life.

HIV is the causative agent of AIDS. HIV is a bloodborne virus that can be transmitted through sexual contact, through a sharps exposure (e.g., needlestick), or from mother to child during pregnancy or childbirth.

Risk factors for acquiring HIV include having unprotected sex, using intravenous drugs (especially if sharing needles), and having another sexually transmitted infection (STI). Being an uncircumcised man increases your risk of acquiring HIV if any of the other risk factors also exist.

A primary HIV infection occurs when a person is first exposed to the virus. Signs and symptoms of primary HIV include flulike symptoms, swollen lymph nodes (especially in the neck), diarrhea, and weight loss.

After the initial infection with HIV, the virus becomes latent (shows no signs or symptoms). During this time, the person will test positive on an HIV blood test, but will not show signs or symptoms of the infection. HIV can remain latent for 18 months to 10 years. If an HIV-positive person is not treated with antiviral drugs, HIV will change from a latent infection to an active one, and it will progress to AIDS.

Signs and symptoms of AIDS include chronic and persistent diarrhea, recurring fevers, night sweats, profound fatigue, weight loss, skin rashes, continual white patches or lesions on the tongue or in the mouth, and repeated opportunistic infections.

Most individuals infected with HIV take about 12 weeks to produce anti-HIV antibodies. The diagnosis of HIV is made by testing a blood sample or a saliva sample for anti-HIV antibodies. Newer generation testing can also detect a protein made by the HIV virus shortly after infection, thus providing a quicker diagnosis. CLIA-waived kits are available for home use, but their results should be confirmed by laboratory tests. Confirmatory tests include the enzyme-linked immunosorbent assay (ELISA) and Western blot testing.

As mentioned, HIV/AIDS currently can be treated but not cured, and without proper and consistent treatment, it is a life-threatening disease. The goal of treatment is to slow the disease progression and allow the person to live a relatively normal life. A regimen of antiviral medications is available to control the virus. There are a number of different drug classes that can be used to control HIV. Most providers recommend using three drugs from at least two different drug classes. This helps to keep the virus from becoming resistant to a single drug. All HIV drugs block the virus from entering the CD4+ T lymphocytes but in different ways.