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Treatment for Lupus/HIV Co-infection
Nov 9, 2003

What is proper treatment for a man who has Lupus and AIDS? He began triple combination therapy about 5 years ago following an AIDS diagnosis, which he tolerates well. He has an undetectable viral load and CD4 counts in the 900-1100 range. He is having significant problems with joint pain, facial rashes and fatigue. Lupus was diagnosed by a dermatologist and he was given a steroid injection, which helped his symptoms for about 5 days only. We have done some research and found that Lupus and HIV almost never occur together and we can not find any recommendations for treatment. Is steroid treatment right for him? Is there a doctor who specializes in Lupus and HIV that could review all his records and make a recommendation?

Response from Dr. Aberg

There are many different treatments for lupus depending on the type of lupus and the organ(s) involved. Topical steroids may be appropiate for some of the skin forms of lupus but you described some symptoms which makes me wonder whether he has systemic lupus. If so, he may need oral medicines. The concern with the treatment for conditions like lupus is that the medications may cause more immunosuppression. Nevertheless, having HIV is not a reason not to treat lupus. There are many rheumatologists who treat connective tissue diseases in persons infected with HIV. I do not know where you live but I suggest you start by asking his doctor. Also, you may want to see if a rheumotologist is at your nearest major medical center. Even if s/he doesn't personally manage HIV, s/he will most likely be able to refer you to the appropriate specialist.

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