Systemic Lupus Erythematosus (SLE) Complicated by Human Immunodeficiency Virus (HIV): A Rare and Challenging Association

Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder characterized by multi-organ inflammation, while human immunodeficiency virus (HIV) primarily compromises host defense by depleting CD4+ T lymphocytes. The pathogenesis of SLE involves dysregulated immunity with autoantibody and immune complex formation, whereas HIV-induced immunosuppression paradoxically predisposes individuals to autoimmune phenomena. The complex interplay between HIV and SLE remains poorly understood, highlighting the importance of accurate differentiation and individualized management in patients affected by both conditions and collaborative management across specialties. We report the case of a 41-year-old male with a three-year history of SLE and suspected lupus nephritis, who had declined a renal biopsy. He later presented with clinical features suggestive of HIV infection. The case underscores the challenges of balancing immunosuppressive therapy in the setting of concomitant autoimmune disease and viral immunodeficiency. The patient was successfully managed with the antiretroviral regimen of dolutegravir and lamivudine, while continuing hydroxychloroquine and corticosteroids. Rituximab was discontinued due to safety concerns and potential drug interactions, considering the benefits of hydroxychloroquine and steroids in managing specific conditions.