AIDS-ASSOCIATED REITERS-SYNDROME

Classically, Reiter's syndrome was defined as a triad of arthritis, ur ethritis, and conjunctivitis. In 1981, the American Rheumatism Associa tion revised its defining criteria for Reiter's syndrome as an episode of peripheral arthritis of more than 1 month's duration occurring in association with urethritis and/or cervicitis. Reiter's syndrome is al so associated with mucocutaneous lesions. Reiter's syndrome was first described in association with the human immunodeficiency virus (HIV) i n 1987. The course of Reiter's syndrome in HIV is more severe, progres sive, and refractory to treatment than in non-HIV-positive patients. T he immunopathogenesis of Reiter's syndrome is linked to HLA-B27, which has been described as the disease susceptibility factor. The associat ion of Reiter's syndrome and HLA-B27 positivity is 80%. Infectious age nts may play a critical role in the initiation or perpetuation of Reit er's syndrome. It has been suggested that an amino acid sequence withi n the HLA-B27 molecule allows microbial peptides to bind and be presen ted to T cytotoxic cells (CD8), which results in a primary T cytotoxic cell response against various tissues. The role of the HIV in the pat hogenesis of Reiter's syndrome is still being investigated. Human immu nodeficiency virus may directly cause arthritis, it may increase the h ost's susceptibility to infection with arthritogenic organisms. Additi onally, HIV infection increases the relative number of CD8 cells, whic h may play a key role in the pathogenesis of Reiter's syndrome. In thi s article, we present a case of Reiter's syndrome in an HLA-B27 and HI V-positive patient, and a review of the literature on the infectious, immunologic, and dermatologic aspects of Reiter's syndrome in HIV dise ase.