Rheumatic manifestations among HIV positive adults attending the Infectious Disease Clinic at Mulago Hospital

Rheumatic manifestations in HIV are common and sometimes the initial presentation of the disease. HIV is now a common infection at the Infectious Disease Clinic, Mulago. The spectrum of joint diseases seen depend on a number of factors such as, the CD4 count, HLA status and current therapy.

This study included HIV patients from a heterogeneous population and was designed to determine the prevalence and clinical pattern of rheumatic manifestations among these HIV patients.

Four hundred eighty seven patients were screened and 300 HIV positive patients were consecutively recruited into the study, evaluated for rheumatic manifestations and their clinical and laboratory findings documented.

The prevalence of rheumatic manifestations was 27% (81 of 300). Arthralgias in 19.3% of the study population were commonest finding followed by HIV associated arthritis at 4.3%. The lower limbs were the most commonly affected with the knees (28.8%) and ankles (26.9%) contributing the highest. All patients had a negative anti-nuclear antibody test, with only two having a positive rheumatoid factor test. An association of antituberculosis drugs with joint disease was further highlighted in this study (OR 3.79 95% CI, 1.44 - 9.93). Septic arthritis due to Staphylococcus aureus was rarely observed except when the patients' level of CD4 + T cells dropped below 200 cells mm(3). The mean CD4+ count was 171 cells mm(3).

Rheumatic manifestations should be considered among HIV positive adults. Arthralgias are common especially in patients using pyrazinamide.