Human Immunodeficiency Virus-Associated Rheumatic Disorders in the HAART Era

JAVIER MARQUEZ, CARLOS S. RESTREPO, LILIANA CANDIA, ALBERTO BERMAN, and LUIS R. ESPINOZA

ABSTRACT.

Objective. To define the frequency and characteristics of human immunodeficiency virus (HIV)-associated rheumatic manifestations in patients receiving highly active antiretroviral therapy (HAART) referred to a rheumatology clinic.

Methods. A total of 75 patients with HIV infection receiving HAART were prospectively evaluated for the presence of rheumatic complaints. Diagnosis of HIV infection was performed by ELISA and confirmed by Western blot, and all HIV patients were classified according to the US Centers for Disease Control criteria.

Results. Seventy-five individuals with HIV infection and musculoskeletal manifestations were evaluated: 65 (86%) men and 10 (14%) women. Mean age was 32 ± 4.5 years (range 21–58). The group included 40 (53%) heterosexuals, 30 (40%) intravenous drugs users, 9 (12%) homosexuals, 3 (4%) who had received blood transfusion, and 2 (2.6%) with unknown risk factors. Septic manifestations were the most common complications seen in 31 (41%) out of 75, and included septic arthritis, cellulitis, osteomyelitis, diskitis, and pyomyositis. Fibromyalgia was present in 13 (17%), seronegative symmetric polyarthritis in 4, oligoarthritis in 4, psoriatic arthritis in 2, carpal tunnel syndrome in 2, and enthesitis in 2. Mutifocal bone non-Hodgkin's lymphoma was present in 7 (9.3%) and Kaposis's sarcoma of bone in 2 (2.6%) patients. Hypertrophic osteoarthropathy in 3 (4%) and aseptic bone necrosis of multiple bones was seen in 3 (4%) patients. Ten patients exhibited only arthralgias. Most patients had moderately elevated erythrocyte sedimentation rate and C-reactive protein. Mean CD4 cell count was 250 mm³ (range 20–450), and mean HIV viral load was 5210 (range 0–75,300) copies/ml.

Conclusion. Rheumatic manifestations were highly frequent in HIV patients receiving HAART referred to a rheumatology clinic, although the clinical spectrum differed from the pre-HAART era with septic and malignant complications being the most common manifestations seen. (J Rheumatol 2004;31:741-6)

Key Indexing Terms:

HIV
ARTHRITIS
SEPTIC ARTHRITIS
TROPICAL PYOMYOSITIS
HAART
KAPOSI'S SARCOMA

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From the Rheumatology Section, Departments of Medicine and Radiology, LSU Health Sciences Center, New Orleans, Louisiana, USA, and the University of Tucuman School of Medicine, Tucuman, Argentina.

J. Marquez, MD, Research Fellow; L, Candia, MD, Research Fellow; C. Santiago Restrepo, MD, Associate Professor; L.R. Espinoza, MD, Professor and Chief, Section of Rheumatology, Departments of Medicine and Radiology, LSU Health Sciences Center; A. Berman, MD, Professor, University of Tucuman School of Medicine.

Address reprint requests to Dr. L.R. Espinoza, LSU Medical Center, 1542 Tulane Avenue, New Orleans, LA, 70112-2822, USA.

Submitted February 28, 2003; revision accepted September 5, 2003.

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