Undiagnosed HIV in Patients on Immunosuppressive Medications Presenting with HIV-Associated Kidney Disease.

IF 1 4区医学 Q3 MEDICINE, GENERAL & INTERNAL

Southern Medical Journal Pub Date : 2024-05-01 DOI:10.14423/SMJ.0000000000001688

Nathaniel Forrester, Jonathan Zhang Suo Keyes, Ronan Cajimat, Yelena Burklin, Mary Ann Kirkconnell Hall, Jason Cobb

{"title":"Undiagnosed HIV in Patients on Immunosuppressive Medications Presenting with HIV-Associated Kidney Disease.","authors":"Nathaniel Forrester, Jonathan Zhang Suo Keyes, Ronan Cajimat, Yelena Burklin, Mary Ann Kirkconnell Hall, Jason Cobb","doi":"10.14423/SMJ.0000000000001688","DOIUrl":null,"url":null,"abstract":"<p><p>Approximately 158,500 adults and adolescents in the United States live with undiagnosed human immunodeficiency virus (HIV). Missed or delayed diagnoses adversely affect disease management and outcomes. This is particularly salient for patients receiving immunosuppressive and immunomodulatory therapy for the management of chronic inflammatory conditions, in which additional immunosuppression may increase the risk and severity of opportunistic infections. Despite this risk, comprehensive HIV testing before the initiation of immunosuppressive therapy is not yet the norm. We describe a case series containing the narratives of three patients recently treated with immunosuppressive agents, who presented with signs concerning for HIV-associated kidney diseases and who were found to have undiagnosed HIV later in the treatment course, which, unfortunately, resulted in poor outcomes. Screening for HIV or related illnesses, such as viral hepatitis or mycobacterial co-infections including tuberculosis, is essential before initiating biologic immunosuppression.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":null,"pages":null},"PeriodicalIF":1.0000,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Southern Medical Journal","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.14423/SMJ.0000000000001688","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}

引用次数: 0

Abstract

Approximately 158,500 adults and adolescents in the United States live with undiagnosed human immunodeficiency virus (HIV). Missed or delayed diagnoses adversely affect disease management and outcomes. This is particularly salient for patients receiving immunosuppressive and immunomodulatory therapy for the management of chronic inflammatory conditions, in which additional immunosuppression may increase the risk and severity of opportunistic infections. Despite this risk, comprehensive HIV testing before the initiation of immunosuppressive therapy is not yet the norm. We describe a case series containing the narratives of three patients recently treated with immunosuppressive agents, who presented with signs concerning for HIV-associated kidney diseases and who were found to have undiagnosed HIV later in the treatment course, which, unfortunately, resulted in poor outcomes. Screening for HIV or related illnesses, such as viral hepatitis or mycobacterial co-infections including tuberculosis, is essential before initiating biologic immunosuppression.

查看原文本刊更多论文

服用免疫抑制药物的患者出现 HIV 相关性肾病时未确诊的 HIV。

在美国，约有 158,500 名成人和青少年感染了未经诊断的人类免疫缺陷病毒（HIV）。漏诊或延误诊断会对疾病管理和治疗效果产生不利影响。对于接受免疫抑制和免疫调节治疗以控制慢性炎症的患者来说，这一点尤为突出，因为额外的免疫抑制可能会增加机会性感染的风险和严重程度。尽管存在这种风险，但在开始免疫抑制治疗前进行全面的 HIV 检测尚未成为常规。我们描述了一个病例系列，其中包括三位近期接受免疫抑制剂治疗的患者的叙述，他们出现了与艾滋病相关的肾脏疾病症状，但在治疗过程的后期发现他们未被诊断出感染了艾滋病，不幸的是，这导致了不良的治疗效果。在开始使用生物免疫抑制剂之前，筛查 HIV 或相关疾病（如病毒性肝炎或包括结核病在内的分枝杆菌合并感染）至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Southern Medical Journal 医学-医学：内科

CiteScore

1.40

自引率

9.10%

发文量

222

审稿时长

4-8 weeks

期刊介绍： As the official journal of the Birmingham, Alabama-based Southern Medical Association (SMA), the Southern Medical Journal (SMJ) has for more than 100 years provided the latest clinical information in areas that affect patients'' daily lives. Now delivered to individuals exclusively online, the SMJ has a multidisciplinary focus that covers a broad range of topics relevant to physicians and other healthcare specialists in all relevant aspects of the profession, including medicine and medical specialties, surgery and surgery specialties; child and maternal health; mental health; emergency and disaster medicine; public health and environmental medicine; bioethics and medical education; and quality health care, patient safety, and best practices. Each month, articles span the spectrum of medical topics, providing timely, up-to-the-minute information for both primary care physicians and specialists. Contributors include leaders in the healthcare field from across the country and around the world. The SMJ enables physicians to provide the best possible care to patients in this age of rapidly changing modern medicine.