Background/Purpose: Sarcoidosis and HIV are thought of as antithetical, one driven by excess, the other by deficiency, of CD4+ T-cells. However, case reports and series describe comorbid sarcoidosis and HIV. To date, there has been no controlled comparison of the incidence and presentation of sarcoidosis in persons with and without HIV infection.

Methods: Patients were selected from the Veterans Administration Cohort Study, a longitudinal cohort of veterans with HIV and age, sex and race-matched uninfected comparators. Among those with at least one ICD code for sarcoidosis, chart review was conducted to confirm incident or prevalent sarcoidosis. Cases where sarcoidosis developed before HIV were excluded from analysis. Incident cases (other than Stage I pulmonary sarcoidosis) were required to have tissue diagnosis and compatible clinical presentation with exclusion of reasonable alternative diagnoses; prevalent cases required documentation of diagnosis only. Organ involvement and immunosuppressive therapy were recorded for one year following the date of biopsy.

Results: Among 1,610 patients with at least one ICD code for sarcoidosis, 875 (54%) had prevalent sarcoidosis and 332 (21%) had incident sarcoidosis. After excluding 9 cases in which sarcoidosis developed before HIV and all prevalent cases, incidence of sarcoidosis among patients living with (N=56,470) and without (N=116,130) HIV was 0.9 (95% CI: 0.7-1.2), versus 1.5 (95% CI: 1.3-1.7) per 10,000 person-years. Uninfected individuals developed sarcoidosis more frequently than those with HIV (rate ratio 1.6 (95% CI: 1.2-2.1)). In those with HIV, sarcoidosis was diagnosed a median of 8.0 years after HIV diagnosis (3.3-15.4). At diagnosis, median CD4 count was 420 cells/mm³ (268-530) and 56% of patients had a viral load < 500 copies/mL. Organ involvement and stage of pulmonary involvement (Figure 1, Figure 2), treatment with systemic glucocorticoids (37% vs 36%, p=0.93) and total dose of prednisone over one year (2195 vs 1800 mg, p=0.97) were all similar by HIV status. Use of steroid-sparing immunosuppressants (methotrexate, hydroxychloroquine, azathioprine and calcineurin inhibitors) tended to be less common in those with HIV (4.8% vs 10.4%, p=0.17).

Conclusion: Compared to those with HIV, those without were 60% more likely to develop sarcoidosis. Most patients with HIV and incident sarcoidosis had CD4 counts over 200, while just over half were virally suppressed. While presentation was similar, as was the use and total dose of oral glucocorticoids, use of steroid-sparing regimens tended to be less common among those with HIV.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/epidemiology-and-presentation-of-sarcoidosis-with-and-without-hiv-infection/