Answered by:
Stuart D. Federman, PharmD, AAHIVP
Gateway Apothecary
Saint Louis, MO


HIV infection can disguise itself as an autoimmune reaction and confirmatory tests should be completed to make sure that patients are diagnosed correctly. Patients with lupus can have symptoms in all organ systems as a result of the body forming an immune response to itself. As a result, most of the therapy that is used for lupus works by suppressing the immune system. Systemic corticosteroids such as prednisone are commonly used as treatment in lupus patients to suppress the immune response.

Corticosteroids and other immunosuppressive therapy should be used cautiously in patients who have low CD4 counts due to active HIV infection. Since these patients are already at a higher risk for infection, they should be monitored more closely and may be placed on additional medication to prevent infections. Patients who are taking Norvir (ritonavir) are at an increased risk of side effects when taking prednisone. These can include increased blood sugar and bone loss. Patients who are at risk for diabetes or osteoporosis or have these conditions need to be followed more closely by providers.

Patients who also have asthma or chronic obstructive pulmonary disease (COPD) may use steroid inhalers to prevent symptoms. These patients should be extra cautious using oral steroids with antiretrovirals for HIV. This could lead to an increased level of hormones that could lead to the development of Cushing’s disease, which makes the pituitary gland release excess levels of the adrenocorticotropic hormone.

Additional writing by Mason Stewart, student pharmacist at the St. Louis College of Pharmacy.