Rheumatic Diseases and HIV: What is the Connection?

Is there a connection between rheumatic diseases and HIV? More than 50 percent of HIV patients experience musculoskeletal symptoms. In some cases, rheumatic diseases are the cause. While the immune system is severely compromised in patients with HIV, inflammatory and autoimmune diseases can still occur.

The Relationship

When a person has HIV, he or she is at risk for a variety of rheumatic manifestations. While the patient may have experienced these without HIV, those with HIV tend to have a different experience with rheumatic diseases and HIV. For some patients, just having the HIV virus can cause them to experience rheumatic symptoms. HIV patients have a variety of risk factors for rheumatic diseases, such as risky behaviors that heighten the chance of developing a rheumatic disease and a weakened immune system. There is also a chance that some HIV medications will cause joint pain, especially the older medications.

Rheumatic Disease Risks

About one in 10 HIV patients will experience reactive arthritis. This type of arthritis occurs after an infection, most commonly a sexually transmitted disease or food poisoning. However, the HIV virus seems to be the trigger.

Psoriatic arthritis is a type of arthritis characterized by psoriasis lesions and joint pain. This type of arthritis is sometimes one of the initial signs of HIV. In fact, when patients present to their doctor with this type of arthritis, most doctors will first order an HIV test.

Septic arthritis does not occur very often in HIV patients, it just occurs differently, from a direct joint infection. In an HIV patient, this type of arthritis is most likely to occur if the patient also has hemophilia, is an injection drug user or has a CD4 count of around 250.

Generalized joint swelling and pain is common in HIV patients, though not as common now with HAART being available. Undiagnosed patients and/or those not receiving HAART often complain of muscle and joint pain and this is sometimes how doctors are prompted to test for HIV.

Reducing the Risk of Rheumatic Diseases and HIV

HIV patients are actually at a lower risk of developing two rather common rheumatic diseases, known as rheumatoid arthritis and systemic lupus erythematosus. However, in HIV-infected populations rheumatoid arthritis may re-emerge due to HAART treatment. This may cause a person being treated with HAART to experience a worsening of any rheumatic disease he or she has. HAART is highly active antiretroviral therapy and is highly effective in improving the symptoms of HIV for many patients.

Resources

American College of Rheumatology. (2008). HIV-Associated Rheumatic Disease Syndromes. Retrieved on March 29, 2011 from the American College of Rheumatology: https://www.rheumatology.org/practice/clinical/patients/diseases_and_conditions/HIV.asp

Maganti, R.M. et al. (2007). Therapy Insight: The Changing Spectrum of Rheumatic Disease in HIV Infection. Retrieved on March 29, 2011 from Clinical Practice Rheumatology: https://www.nature.com/nrrheum/journal/v4/n8/full/ncprheum0836.html