Rheumatologic manifestations of pediatric human immunodeficiency virus infection

Multiple rheumatologic signs and symptoms have been described in adult human immunodeficiency virus (HIV) infection. Our goals were to determine the incidence and characteristics of rheumatologic manifestations in HIV infected children, and to examine their relationship to laboratory evidence of autoimmunity.

Forty HIV infected children were studied by means of a questionnaire, history, examination, and serologic testing including determination of concentrations of immunoglobulin, C3, C4, and of presence of antinuclear antibodies (ANA), rheumatoid factor (RF), and circulating immune complexes (CIC).

Rheumatologic manifestations included arthralgia (15%), myalgia (8%), erythema multiforme (3%), and parotitis (20%). Hypergammaglobulinemia (98%), hypocomplementemia (25%), RF (10%), ANA (3%), and CIC (82% of patients studied) were also found. Patients with or without rheumatologic manifestations did not differ significantly in any laboratory variable measured.

In contrast to HIV infected adults, HIV infected children, do not display serious rheumatologic manifestations. Mild rheumatologic symptoms are common, but there is little evidence that these are immune mediated. Parotid enlargement occurs and must be differentiated from Sjögren's syndrome. Differences between rheumatologic manifestations of HIV infection in children and adults may reflect host factors such as the immaturity of the pediatric immune system, or environmental factors such as modes of acquisition of HIV, duration of HIV infection, or exposure to other sexually transmitted organisms.