Biopsy-Proven Lupus Nephritis in a Patient Living with HIV: Autoimmunity in Immunodeficiency- A Case Report

The coexistence of Systemic Lupus Erythematosus (SLE) and Human Immunodeficiency Virus (HIV) infection represents a rare and complex clinical entity due to opposing immunological mechanisms. While HIV leads to immunodeficiency through CD4+ T-cell depletion, SLE is characterized by immune hyperactivity and autoantibody production.

We report a 50-year-old female, a known Person Living with HIV (PLHIV) on Highly Active Antiretroviral Therapy (HAART), who presented with polyarthritis, alopecia, and significant weight loss. Laboratory evaluation revealed pancytopenia, markedly elevated anti-dsDNA antibodies, hypocomplementemia, and significant proteinuria. HIV disease was well controlled, with a CD4 count of 600 cells/mm³ and a low viral load of 120 copies/mL at presentation. Renal biopsy demonstrated focal mesangial and endocapillary hypercellularity, while immunofluorescence showed granular deposition of IgG, C3, and C1q, confirming Class 3 (ISN/RPN) lupus nephritis. The patient was treated with corticosteroids, hydroxychloroquine, and mycophenolate mofetil, along with cotrimoxazole prophylaxis and continuation of HAART. On follow-up after 6 months, she achieved complete renal remission with stable HIV disease status and is currently maintained on low-dose corticosteroids, mycophenolate mofetil, hydroxychloroquine, and HAART.

This case highlights the diagnostic and therapeutic challenges of autoimmune disease in an immunocompromised host and underscores that effective viral suppression with preserved immune status permits safe and effective use of standard immunosuppressive therapy.