Sarcoidosis after highly active antiretroviral therapy in a patient with AIDS

The occurrence of sarcoidosis and HIV infection in the same individual has been reported infrequently.1 HIV‐induced CD4 T‐lymphocyte suppression might lead to the disappearance of some of the clinical manifestations of sarcoidosis.2 By contrast, highly active antiretroviral therapy (HAART)‐induced immune restitution could reactivate sarcoidosis.3 Since the advent of HAART, sarcoidosis has been increasingly recognized as part of the immune restoration syndrome in AIDS patients.1, 4, 5 On the other hand, cutaneous intolerance to tattoos in an HIV‐infected patient as a manifestation of the immune restoration syndrome has been previously reported6 and a granulomatous tattoo reaction has been described as a manifestation of sarcoidosis.7 HAART − that has potent in vivo effects on HIV‐1 replication − has led to significant decreases in AIDS‐associated morbidity and mortality.8 Inflammatory reactions involving opportunistic infections, AIDS‐associated malignant conditions, and other noninfectious diseases have recently been described in patients infected with HIV‐1; these conditions often appeared shortly after the introduction of HAART and were associated with pronounced reductions in plasma HIV‐1 viral load and increases in CD4 T‐lymphocyte counts.