{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T00:04:40Z","timestamp":1756339480826,"version":"3.44.0"},"reference-count":23,"publisher":"BMJ","issue":"6","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,5,21]]},"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:p>Advancements in antiretroviral therapy (ART) have significantly improved the survival of HIV-infected individuals but have also altered the landscape of HIV-associated renal diseases. While HIV-associated nephropathy incidence has decreased, other renal complications have emerged due to ART-related nephrotoxicity, coinfections, comorbidities and immune dysregulation. Antineutrophil cytoplasmic antibodies (ANCAs) have been detected in HIV-infected patients, with prevalence varying significantly (13%\u201383%) depending on factors such as disease stage and methodology. Recent studies reported a prevalence of approximately 13% ANCA positivity in HIV patients with stable immunovirological status on ART, indicating a lower prevalence in this subgroup. Despite this variability, clinically significant ANCA-associated vasculitis (AAV) remains rare. We report the case of a woman in her 40s with stable HIV infection who developed systemic microscopic polyangiitis with severe renal impairment. Despite complexity, she achieved remission with methylprednisolone, plasma exchange and cyclophosphamide. This case underscores the clinical importance of recognising genuine AAV among HIV patients, particularly following ART regimen changes, emphasising early identification and tailored management.<\/jats:p>","DOI":"10.1136\/bcr-2024-262359","type":"journal-article","created":{"date-parts":[[2025,6,12]],"date-time":"2025-06-12T04:30:27Z","timestamp":1749702627000},"page":"e262359","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["ANCA-associated vasculitis in a middle-aged woman with HIV: a complex interplay and therapeutic challenges"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-0790-421X","authenticated-orcid":false,"given":"Sreejith","family":"Prathapa Chandran Vanajakumari","sequence":"first","affiliation":[{"name":"Internal Medicine, Armed Forces Medical College, Pune, Maharashtra, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2079-128X","authenticated-orcid":false,"given":"Parikshit","family":"Chauhan","sequence":"additional","affiliation":[{"name":"Internal Medicine, Armed Forces Medical College, Pune, Maharashtra, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Atul Kumar","family":"Srivastava","sequence":"additional","affiliation":[{"name":"Nephrology, Command Hospital Pune, Pune, Maharashtra, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sachin","family":"Srivastava","sequence":"additional","affiliation":[{"name":"Nephrology, Command Hospital Pune, Pune, Maharashtra, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,6,12]]},"reference":[{"key":"2025082707375079000_18.6.e262359.1","doi-asserted-by":"crossref","first-page":"S20","DOI":"10.2215\/CJN.03561006","article-title":"HIV-1 and HIV-Associated Nephropathy 25 Years Later","volume":"2 Suppl 1","author":"Wyatt","year":"2007","journal-title":"Clin J Am Soc Nephrol"},{"doi-asserted-by":"publisher","key":"2025082707375079000_18.6.e262359.2","DOI":"10.1016\/j.kint.2017.11.007"},{"key":"2025082707375079000_18.6.e262359.3","first-page":"1655","article-title":"Kidney Diseases Associated with Human Immunodeficiency Virus Infection","volume":"378","author":"Cohen","year":"2018","journal-title":"N Engl J Med"},{"key":"2025082707375079000_18.6.e262359.4","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000006230","article-title":"Nonorgan-specific autoantibodies in HIV-infected patients in the HAART era","volume":"96","author":"Iordache","year":"2017","journal-title":"Medicine (Baltimore)"},{"doi-asserted-by":"publisher","key":"2025082707375079000_18.6.e262359.5","DOI":"10.1016\/j.autrev.2014.04.005"},{"key":"2025082707375079000_18.6.e262359.6","doi-asserted-by":"crossref","first-page":"1227","DOI":"10.1016\/0140-6736(90)92755-7","article-title":"'False-positive' anti-neutrophil cytoplasmic antibodies in HIV infection","volume":"335","author":"Koderisch","year":"1990","journal-title":"Lancet"},{"doi-asserted-by":"crossref","unstructured":"Evans R , Gueret-Wardle A , Edwards S , et al . ANCA-associated vasculitis and pauci-immune glomerulonephritis in HIV disease. BMJ Case Rep 2014;2014. doi:10.1136\/bcr-2013-202423","key":"2025082707375079000_18.6.e262359.7","DOI":"10.1136\/bcr-2013-202423"},{"key":"2025082707375079000_18.6.e262359.8","first-page":"270","article-title":"ANCA seropositivity in HIV: a serological pitfall","volume":"63","author":"Jansen","year":"2005","journal-title":"Neth J Med"},{"key":"2025082707375079000_18.6.e262359.9","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1097\/IPC.0b013e3182601ea1","article-title":"Antineutrophil Cytoplasmic Autoantibody\u2013Associated Systemic Vasculitis is Associated With Epstein-Barr Virus in the Setting of HIV Infection","volume":"21","author":"Mirsaeidi","year":"2013","journal-title":"Infect Dis Clin Pract (Baltim Md)"},{"doi-asserted-by":"publisher","key":"2025082707375079000_18.6.e262359.10","DOI":"10.1016\/j.kint.2023.10.008"},{"doi-asserted-by":"publisher","key":"2025082707375079000_18.6.e262359.11","DOI":"10.1136\/ard-2022-223764"},{"key":"2025082707375079000_18.6.e262359.12","doi-asserted-by":"crossref","first-page":"691","DOI":"10.6061\/clinics\/2015(10)06","article-title":"Proteinuria is common among HIV patients: what are we missing?","volume":"70","author":"Antonello","year":"2015","journal-title":"Clinics (Sao Paulo)"},{"doi-asserted-by":"publisher","key":"2025082707375079000_18.6.e262359.13","DOI":"10.1007\/BF02560504"},{"key":"2025082707375079000_18.6.e262359.14","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1111\/j.1365-2249.1992.tb06408.x","article-title":"Anti-neutrophil cytoplasmic autoantibodies in patients with symptomatic HIV infection","volume":"87","author":"Klaassen","year":"1992","journal-title":"Clin Exp Immunol"},{"doi-asserted-by":"publisher","key":"2025082707375079000_18.6.e262359.15","DOI":"10.1097\/RHU.0b013e31826d2005"},{"key":"2025082707375079000_18.6.e262359.16","doi-asserted-by":"crossref","first-page":"205","DOI":"10.3109\/08916939409007997","article-title":"Anti-nuclear, anti-neutrophil cytoplasmic and anti-glomerular basement membrane antibodies in HIV-infected individuals","volume":"18","author":"Savige","year":"1994","journal-title":"Autoimmunity"},{"key":"2025082707375079000_18.6.e262359.17","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1055\/s-0041-1731945","article-title":"A Comparative Evaluation of Antigen-Specific Sandwich Immunoassay and Indirect Immunofluorescence Assay (IIF) in Detecting Antineutrophil Cytoplasmic Antibodies: Are We Ready to Replace IIF with ELISA as the Primary Screening Method?","volume":"13","author":"Deka","year":"2021","journal-title":"J Lab Physicians"},{"key":"2025082707375079000_18.6.e262359.18","doi-asserted-by":"crossref","DOI":"10.1016\/j.autrev.2020.102716","article-title":"The value of anti-neutrophil cytoplasmic antibodies (ANCA) testing for the diagnosis of ANCA-associated vasculitis, a systematic review and meta-analysis","volume":"20","author":"Guchelaar","year":"2021","journal-title":"Autoimmun Rev"},{"key":"2025082707375079000_18.6.e262359.19","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1186\/s12882-023-03244-9","article-title":"ANCA-associated vasculitis in a HIV-infected patient:a case-based review","volume":"24","author":"Vornicu","year":"2023","journal-title":"BMC Nephrol"},{"doi-asserted-by":"publisher","key":"2025082707375079000_18.6.e262359.20","DOI":"10.1177\/039463201302600414"},{"doi-asserted-by":"publisher","key":"2025082707375079000_18.6.e262359.21","DOI":"10.4103\/0971-4065.97117"},{"key":"2025082707375079000_18.6.e262359.22","doi-asserted-by":"crossref","first-page":"1426","DOI":"10.1177\/0956462420946662","article-title":"Rituximab in people living with HIV affected by immune-mediated renal diseases: a case-series","volume":"31","author":"Alfano","year":"2020","journal-title":"Int J STD AIDS"},{"doi-asserted-by":"publisher","key":"2025082707375079000_18.6.e262359.23","DOI":"10.1093\/jac\/dki444"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2024-262359","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T14:38:02Z","timestamp":1756305482000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2024-262359"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6]]},"references-count":23,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2025,6,12]]},"published-print":{"date-parts":[[2025,6]]}},"alternative-id":["10.1136\/bcr-2024-262359"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2024-262359","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2025,6]]}}}