Introduction Autoimmune and systemic diseases (ADs) were described in HIV infected patients and a classification by immune status was proposed.

Methods HIV-infected patients that presented an AD in the infectious diseases department of La Rabta University hospital in Tunis (Tunisia) were retrospectively included.

Results Four patients were included. The ADs were spondylo-arthropathy, Behçet disease and psoriasis.Two patients presented Behçet disease. In two patients, the AD preceded HIV infection and in the two others, HIV infection was diagnosed at the same time as the AD. In all cases, ADs occurred in patients with a CD4 T lymphocyte count of more than 200/mm³. No co-infection with hepatitis B or C viruses was diagnosed.Three patients received anti-inflammatory drugs and one patient received immunosuppressant treatment with good tolerance.

Conclusion AD and autoantibodies are present in HIV infection. AD may develop during acute viral infection (Stage I), with normal to low CD4 counts (Stage II). However, past a threshold where the CD4 count is profoundly low, AD cannot develop (Stage III). Following HAART, immune restoration (normal CD4 count) with possible altered immune regulation may lead to the emergence of AD (Stage IV). More studies are necessary to identify the subgroups of HIV-infected patients that may be prone to develop AD. Co-infection with hepatitis B or C viruses should be screened.