Rheumatic manifestations associated with HIV in the highly active antiretroviral therapy era

Abstract

In the HAART era, HIV-infected individuals can be affected by various rheumatic syndromes including arthritis, spondyloarthritis, DILS, vasculitides, connective tissue disease, myopathies, and musculoskeletal diseases. With the use of HAART, the prevalence of spondyloarthritis and Diffuse Infiltrative Lymphocytosis Syndrome has decreased, whereas the musculoskeletal complications of HIV and HAART, such as osteopenia, osteonecrosis, and infection continue to be a concern. With immune restoration, various inflammatory and autoimmune diseases, such as SLE, rheumatoid arthritis, and polymyositis may occur de novo or exacerbate. Most antirheumatic therapies used in HIV-negative individuals appear to be safe and effective in the setting of HIV infection as long as prudent guidelines are followed.

Simian Immunodeficiency Virus-Induced Alterations in Monocyte Production of Tumor Necrosis Factor Alpha Contribute to Reduced Immune Activation in Sooty Mangabeys

“…These findings suggest that therapeutic intervention aimed at reducing TNF-␣ may be beneficial for reducing immune activation during HIV infection. Indeed, TNF-␣ inhibitors have been utilized for the treatment of inflammatory conditions in HIV-infected patients (15,23,35,44). However, none of the studies performed to date has measured indicators of immune activation or monocyte function following treatment.…”

Anti-cyclic citrullinated peptide and rheumatoid factor in HIV positive patients

“…Also, the lack of the RA comparison group might be explained with very diYcult age/gender adjustment because of the characteristics of RA population. On the other hand, HIV positive patients have a tendency to develop rheumatoid arthritis-like diseases in all phases of the infection [3,4,16,17]. That is the reason it would be of a great interest to investigate the HIV positive patients after the detailed rheumatological examination in order to obtain the detailed clinical picture of HIV positive patients, so the new discoveries could be combined with the data obtained in our research.…”

Polymyalgia Rheumatica as the First Presentation of Metastatic Lymphoma

“…Avascular necrosis of the bones (osteonecrosis) may occur due to either HIV infection or HAART (particularly protease inhibitor). It is also associated with a low CD4-T lymphocyte count (4)(5)(6).…”

“…Rheumatic disorders are common manifestations in HIVinfected patients and continue to be prevalent despite the introduction of highly active anti-retroviral therapy (HAART) (4,5). These conditions can occur as the direct result of HIV infection, a consequence of immune deficiency or a result of HIV-related treatment (6).…”