Distinctive rheumatic manifestations in 98 patients with human immunodeficiency virus infection in China

To analyze the spectrum and risk factors of rheumatic manifestations in patients with human immunodeficiency virus (HIV) infection.

Ninety-eight consecutive inpatients with HIV infection admitted to Peking Union Medical College Hospital from 1999 to 2006 were studied. Demographic data, routes of transmission, clinical features, and laboratory findings were collected and a database was established. Laboratory studies included blood CD3+, CD4+, CD8+, CD19+, CD16+CD3+, CD4+CD28+, CD8+CD28+, HLA- DR+CD8+, and CD8+CD38+ lymphocyte counts, and antinuclear antibody tests. Hepatitis C virus (HCV) infection was also investigated in each patient. Risk factors for the rheumatic manifestations of HIV infection were assessed by logistic regression analysis.

Rheumatic manifestations were found in 53 (54.08%) HIV patients. Vasculitis was the most common finding (20 cases; 20.41%), including 15 cases of Behçet-like disease, 2 cases each of Henoch-Schönlein purpura and digital gangrene, and one case of central nervous system vasculitis. Other common rheumatic manifestations included Sjögren-like syndrome/diffuse infiltrative lymphocytosis syndrome (DILS; 11 cases; 11.22%), lupus-like syndrome (10 cases; 10.20%), of which 5 cases had renal involvement, and myositis (8 cases; 8.16%) including one case of zidovudine-induced myositis. No case of spondyloarthropathy was observed. Logistic regression analysis showed that Centers for Disease Control CD4+ T cell staging, erythrocyte sedimentation rate, and HCV infection were risk factors for HIV patients to develop rheumatic manifestations [p = 0.01, odds ratio (OR) = 31.80; p = 0.02, OR = 2.93; p = 0.01, OR = 17.47, respectively].

Rheumatic disorders such as vasculitis, Sjögren-like syndrome/DILS, lupus-like syndrome, and myositis were common in Chinese patients with HIV, while articular disorders were rare. CD4+ T cell depletion and HCV coinfection may predispose patients with HIV to develop rheumatic manifestations.