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Artrite reumatoide e infeção VIH : revisão da literatura a propósito de um caso clínico
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Orientador(es)
Resumo(s)
O aumento da sobrevida dos doentes infetados com o Vírus da Imunodeficiência Humana, devido ao avanço da terapêutica antirretroviral, implica que se assista, atualmente, a uma maior incidência de patologias crónicas concomitantes nestes doentes, nomeadamente do foro reumatológico. Entre as doenças reumatológicas, a Artrite Reumatoide adquire particular importância, dado que a sua terapêutica implica imunossupressão. Apesar da diversidade de fármacos disponíveis na terapêutica da AR, que permite uma abordagem mais individualizada dos doentes, existem ainda dados limitados para orientar a terapêutica em doentes com coinfeção VIH.
Adicionalmente, a coexistência destas patologias tem motivado controvérsia, pois, sabendo-se que os linfócitos T CD4+ desempenham um papel central na fisiopatologia da AR, seria de esperar que esta doença não se desenvolvesse em doentes gravemente imunodeprimidos. Esta observação é um exemplo ilustrativo da complexidade da fisiopatologia da AR.
Apresenta-se um caso de uma mulher com infeção VIH, a quem foi diagnosticada AR, com envolvimento pulmonar e hematológico. Foi instituída terapêutica com Tocilizumab, tendo realizado sete ciclos de administração até à data da colheita destes dados. Verificou-se uma melhoria clínica significativa a nível articular, hematológico e constitucional, sem ocorrência de efeitos adversos graves.
A propósito deste caso clínico, faz-se uma revisão da literatura.
Since patients infected with Human Immunodeficiency Virus are now living longer as a result of effective antiretroviral therapy, the prevalence of chronic comorbidities, such as rheumatic diseases, has increased. Rheumatoid Arthritis requires special attention, as the administration of immunosuppressive therapy in the treatment of this disease is a challenge in patients with HIV. There is a wide range of drugs available for the treatment of RA, with the opportunity to address each patient as a particular case. Nevertheless, concerning treatment of RA in a patient with coexisting HIV infection, evidence is still limited. On the other hand, the coexistence of these pathologies, even in cases of severe immunosuppression, is a paradox and a good example of the complexity of RA’s physiopathology, in which CD4+ T cells have a central role. We report a clinical case of a patient with HIV infection who was diagnosed with RA, with pulmonary and hematologic involvement. The patient started therapy with Tocilizumab and seven cycles had been administered by the time that this data was collected. There was a significant constitutional improvement with benefit in both articular and hematologic disease, without occurrence of major side-effects. This clinical case report is completed with a literature review.
Since patients infected with Human Immunodeficiency Virus are now living longer as a result of effective antiretroviral therapy, the prevalence of chronic comorbidities, such as rheumatic diseases, has increased. Rheumatoid Arthritis requires special attention, as the administration of immunosuppressive therapy in the treatment of this disease is a challenge in patients with HIV. There is a wide range of drugs available for the treatment of RA, with the opportunity to address each patient as a particular case. Nevertheless, concerning treatment of RA in a patient with coexisting HIV infection, evidence is still limited. On the other hand, the coexistence of these pathologies, even in cases of severe immunosuppression, is a paradox and a good example of the complexity of RA’s physiopathology, in which CD4+ T cells have a central role. We report a clinical case of a patient with HIV infection who was diagnosed with RA, with pulmonary and hematologic involvement. The patient started therapy with Tocilizumab and seven cycles had been administered by the time that this data was collected. There was a significant constitutional improvement with benefit in both articular and hematologic disease, without occurrence of major side-effects. This clinical case report is completed with a literature review.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2015
Palavras-chave
VIH Artrite reumatoide DMARDs