Routine screening for HIV in rheumatology practice.

Area of Science:

• Rheumatology
• Infectious Diseases
• Immunology

Background:

• Rheumatologic manifestations are recognized features of human immunodeficiency virus (HIV) infection.
• The spectrum of rheumatic disorders in HIV-infected individuals has evolved since the introduction of highly active antiretroviral therapy (HAART).
• HIV infection can present during or after immunosuppressive therapy for rheumatic diseases, potentially mimicking or exacerbating underlying conditions.

Observation:

• Two cases of patients with established systemic rheumatic disease who developed complications initially attributed to their rheumatic condition or its treatment are presented.
• These complications were ultimately found to be due to previously undiagnosed HIV infection.
• Overlapping symptoms between rheumatic diseases, immunosuppressive therapy, and HIV infection can lead to diagnostic challenges.

Findings:

• HIV infection can present with rheumatologic symptoms that may be mistaken for primary rheumatic disease or treatment side effects.
• Systemic rheumatic disease patients, particularly those on disease-modifying antirheumatic therapy (DMARDs), are at risk for undiagnosed HIV.
• Routine HIV screening is recommended for patients with systemic rheumatic diseases, aligning with current public health guidelines.

Implications:

• Timely recognition and diagnosis of HIV in patients with rheumatic diseases are critical for effective management and improved patient outcomes.
• Systematic HIV evaluation should be considered for all patients with systemic rheumatic diseases, especially those undergoing or considering immunosuppressive treatments.
• Integrating HIV screening into rheumatology care can help identify cases that might otherwise be missed, preventing delayed treatment and potential complications.