Rheumatic manifestations in HIV-infected patients

Various rheumatic manifestations may develop in HIV-infected patients. In the musculoskeletal system the main conditions which have been reported are reactive, psoriatic or rheumatoid-like arthritis, gout, infective arthritis, osteomyelitis, osteomalacia, osteonecrosis, myositis, pyomyositis and rhabdomyolysis. In addition, manifestations resembling connective tissue diseases may be seen, particularly systemic lupus erythematosus (SLE), Sjogren's syndrome and a whole spectrum of conditions characterized by vasculitis (polyarteritis nodosa, primary vasculitis of the central nervous system, Henoch-Schonlein purpura, Wegener's granulomatosis etc.). Latterly, a correlation has been found between TNF alpha levels and parameters of the progression of HIV-infection, and many studies have shown that anti-TNF alpha drugs are relatively safe and can provide improvement of specific rheumatic disorders in HIV-infected patients. As HIV-infection has become a pandemic, knowledge of these manifestations in everyday clinical practice is of great importance, because of problems in differential diagnosis between this infection and other autoimmune diseases. The production of autoantibodies in rheumatic diseases can affect the detection of anti-HIV antibodies, leading to false positive results in ELISA. Conversely, HIV-infection and antiretroviral therapy can modify the course of many rheumatic diseases, while the risk of side effects due to antirheumatic drugs may be increased in HIV (+) patients.