What diseases cause immunosuppression (immune response suppression)?

From the Guidelines

Diseases that cause suppression of the immune response include HIV/AIDS, certain cancers like leukemias and lymphomas, autoimmune disorders such as lupus and rheumatoid arthritis, congenital immunodeficiency disorders, malnutrition, chronic infections, diabetes, advanced kidney and liver diseases, and aging. These conditions can impair immune function through various mechanisms, such as disrupting normal blood cell production, altering white blood cell function, or causing metabolic disturbances. Some of the key diseases and their effects on the immune system are:

• HIV/AIDS: directly attacks CD4+ T cells, crucial for coordinating immune responses 1
• Certain cancers: impair immune function by disrupting normal blood cell production, with a tenfold higher risk for viral and a sevenfold higher risk for bacterial infections in multiple myeloma 1
• Autoimmune disorders: can lead to immune suppression, either from the disease itself or from immunosuppressive treatments, such as corticosteroids, methotrexate, and TNF-α antagonists 1
• Congenital immunodeficiency disorders: cause immune dysfunction from birth, such as Severe Combined Immunodeficiency (SCID) and Common Variable Immunodeficiency (CVID)
• Malnutrition: can severely compromise immunity, particularly protein deficiency
• Chronic infections: can exhaust the immune system over time, such as tuberculosis and hepatitis
• Diabetes: can impair immune function through vascular damage and altered white blood cell function
• Advanced kidney and liver diseases: affect immunity through metabolic disturbances and the accumulation of toxins
• Aging: naturally diminishes immune responses through immunosenescence Patients with these conditions require careful monitoring for infections and may need prophylactic antibiotics, antifungals, or antivirals depending on their specific risk factors. It is essential to consider the underlying disease and its treatment when evaluating the risk of infection and the need for vaccination or other preventive measures, as some treatments, such as immunosuppressive therapies, can further increase the risk of infection 1.

From the FDA Drug Label

The rate of infectious complications increases with increasing corticosteroid dosages. Varicella and measles can have a serious or even fatal course in non-immune patients taking corticosteroids, including prednisone tablets Hepatitis B virus reactivation can occur in patients who are hepatitis B carriers treated with immunosuppressive dosages of corticosteroids, including prednisone tablets Corticosteroids, including prednisone tablets, may exacerbate systemic fungal infections; therefore, avoid prednisone tablets use in the presence of such infections unless prednisone tablets is needed to control drug reactions Corticosteroids, including prednisone tablets, may activate latent amebiasis Corticosteroids, including prednisone tablets, should be used with great care in patients with known or suspected Strongyloides (threadworm) infestation Cyclosporine is a potent immunosuppressive agent that in animals prolongs survival of allogeneic transplants involving skin, kidney, liver, heart, pancreas, bone marrow, small intestine, and lung Cyclosporine has been demonstrated to suppress some humoral immunity and to a greater extent, cell-mediated immune reactions such as allograft rejection, delayed hypersensitivity, experimental allergic encephalomyelitis, Freund's adjuvant arthritis, and graft vs. host disease in many animal species for a variety of organs

The diseases that may cause suppression of immune response include:

• Hepatitis B: Reactivation can occur in patients who are hepatitis B carriers treated with immunosuppressive dosages of corticosteroids.
• Varicella and measles: Can have a serious or even fatal course in non-immune patients taking corticosteroids.
• Systemic fungal infections: May be exacerbated by corticosteroids.
• Amebiasis: May be activated by corticosteroids.
• Strongyloides infestation: May lead to hyperinfection and dissemination with widespread larval migration, often accompanied by severe enterocolitis and potentially fatal gram-negative septicemia, in patients treated with corticosteroids. These conditions may be affected by the use of immunosuppressive agents such as corticosteroids 2 and cyclosporine 3.

From the Research

Diseases Causing Suppression of Immune Response

• Human Immunodeficiency Virus (HIV) infection is known to cause suppression of the immune response, making individuals more susceptible to various opportunistic infections and cancers, including non-Hodgkin's lymphoma (NHL) and Hodgkin's lymphoma (HL) 4, 5, 6.
• Autoimmune diseases, such as systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), psoriasis (PsO), ankylosing spondylitis (AS), and primary Sjogren's syndrome (pSS), have been linked to an increased risk of overall malignancy, including lymphomas 7.
• Certain viruses, including Epstein-Barr virus (EBV), human cytomegalovirus (HCMV), Human papillomavirus (HPV), and Kaposi's sarcoma-associated herpesvirus (KSHV), have been implicated in AIDS-associated malignancies, including leukemia 8.
• Human T-cell leukemia virus-1 (HTLV-1) has been etiologically associated with leukemia, and recent evidence suggests that EBV, HBV, HCV, and KSHV may also play a role in the development of some types of leukemia 8.

Immune Suppression and Cancer

• The suppression of the immune response in HIV-infected individuals increases the risk of developing various cancers, including NHL and HL 4, 6.
• The introduction of combination antiretroviral therapy (cART) has improved outcomes for HIV-infected individuals with lymphoma, but the optimal treatment of AIDS-related lymphomas remains a challenge, particularly in patients with severe immunosuppression 4.
• Persistent immune activation and inflammation despite sustained antiretroviral therapy (ART)-mediated viral suppression has emerged as a major challenge of the modern HIV treatment era, and is associated with an increased risk of non-AIDS morbidities, including cardiovascular disease 5.