Vasculitic Syndromes

Publications on vasculitic syndromes are even scarcer. The incidence of vasculitides (excluding adverse drug reactions) in HIV- infected patients has been estimated to be 1% or lower.

Category 1

Vasculitides, rarely reported in HIV-infect­ed patients, include temporal arteritis, Takayasu’s arteritis [14], Behςet^,s syndrome [15-17], Churg-Strauss syndrome [18], Wegener’s granulomatosis, essential mixed cryoglobulinemia (hepatitis C virus-related) vasculitides, and Henoch-Schonlein purpura [19, 20]. To date, the role of HIV in the development of these diseases has not yet been proven.

Category 2

This category comprises vasculitides includ­ing adverse drug reactions and diseases caused by/associated with infectious agents. Hypersensitivity reactions to drugs are com­mon in HIV patients because of the number and types of medications they take. Directly or indirectly, microbial pathogens — cyto­megalovirus, Toxoplasma gondii (central nervous system vasculitis), Pneumocystis jiroveci (ex carinii) pneumonia (pulmonary vasculitis) and hepatitis B virus — have been considered the causal agents of vas- culitides, whose development may be direct­ly influenced by preexisting HIV disease. Hepatitis B virus is a well-known cause of polyarteritis nodosa (PAN) in the HIV-nega­tive population. Approximately 5% of PAN in HIV individuals can be attributed to hep­atitis B [21, 22].

Category 3

Vasculitides with no known etiologies that appear to have a relationship with HIV dis­ease comprise category 3. In most cases, the association is inferential, based on unusual presentations that do not fit previously defined clinical diseases or disproportion­ate numbers of rare illnesses among HIV- infected patients. In the absence of epi­demiological studies specifically designed to collect data in this setting, it is impossi­ble to definitively know whether these dis­eases are directly linked to HIV. Microscop­ic polyangiitis-like and PAN-like illnesses in the absence of hepatitis B virus infection have been reported in HIV patients; howev­er, the real numbers remain unknown [23-25]. HIV patients can develop gangrene in the fingers and/or toes [23-25]. Kawasaki- like syndrome appears to be associated with HIV infection, based on 11 adult cases reported in the literature [26-33].