Musculoskeletal Manifestations of HIV Infection in Thailand: An Analysis of 100 Cases

HIV infection is common and a severe problem in Thailand. The clinical features of 100 HIV-infected patients (86 males and 14 females) with musculoskeletal symptoms were studied. Thirty-one patients were known to have HIV infection before developing musculoskeletal symptoms. The musculoskeletal manifestations were undifferentiated (seronegative) arthritis (UA) in 38, bone and joint infections in 30, psoriatic arthritis in 9, AIDS-associated arthritis in 9, Reiter's syndrome in 8, infectious myositis in 3, arthralgia syndrome in 2, and CPPD crystal-associated arthritis in 1 patient. Salmonella spp., Staphylococcus aureus, and the fungus, Penicillium marneffei, were the three most common organisms responsible for bone and joint infections. Mixed bacterial and fungal arthritis was not uncommon and septic arthritis was often polyarticular. Nine of 30 patients with bone and joint infections died.Patients with seronegative arthritis including Reiter's syndrome, psoriatic arthritis, UA, and AIDS-associated arthritis presented with oligoarthritis or polyarthritis involving the lower extremity joints. Enthesopathy was common. These latter arthritides usually responded well to NSAIDs alone. The severe cutaneous lesions of Reiter's syndrome and psoriasis responded well to etretinate. Bone and joint infections were common in clinically full blown AIDS Thai patients and had a poor outcome. The seronegative arthritides were common in otherwise asymptomatic HIV infection and at least in the short term had a favorable outcome.