SLE or HIV? Dilemma for the Caribbean clinician! - abstract

ABSTRACT

Systemic lupus erythematosus (SLE) is not an uncommon disease in the Caribbean. The clinical presentation though often characteristic can include a variety of non-specific symptoms. HIV infection, an increasing problem in the region, can mimic rheumatological diseases like SLE. This paper highlights the clinical and serological overlap of these two conditions. A 24-year old female presenting with fever, cough, weight loss, polyarthralgia and alopecia was treated for SLE. The possibility of AIDS was entertained. HIV antibody was positive by ELISA testing. Western Blot analysis was indeterminate with non-viral bands indicating a false positive ELISA test. The eventual outcome supported a final diagnosis of SLE. Four months after presentation, HIV antibody was negative by both ELISA and Western Blot analysis. This case prompted a retrospective analysis of medical records and a further three cases of SLE with false positive HIV tests by ELISA were identified. In a fourth patient with nephritis, the finding of a positive HIV by ELISA pre-empted therapeutic intervention. This patient succumbed. Ante-mortem blood samples were strongly positive for antinuclear factor and double-stranded DNA but negative for HIV by Western Blot. Caribbean clinicians should therefore be made aware of the possibility that HIV can mimic rheumatological disease and that rheumatological disease can result in false positive tests for HIV. The specific immunoblot techniques would be the investigation of choice in suspicious cases (AU)