Suri Deepti, Sharma Avinash, Bhattad Sagar, Rawat Amit, Arora Sunil, Minz Ranjana W, Singh Surjit
Allergy-Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Department of Immuno-Pathology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Int J Rheum Dis. 2016 Oct;19(10):1018-1023. doi: 10.1111/1756-185X.12947. Epub 2016 Jul 26.
Children with human immunodeficiency virus (HIV) infection usually present with recurrent and unusual infections. Although reported among adults, arthritis as a predominant presentation in children with HIV is rare. Reactive arthritis is considered to be the most common musculoskeletal manifestation in adults with HIV infection. However, in children, septic or HIV-related arthritis has been described. We report four children having arthritis with HIV disease and their long-term outcome; out of which three had human leukocyte antigen (HLA)-B27-related arthritis. It is important to be aware of arthritic presentation of HIV disease in children to prevent delay in diagnosis and initiation of appropriate therapy.
Clinical profile of children with HIV infection who presented with arthritis and registered at the Pediatric Immunodeficiency Clinic at PGIMER, Chandigarh were reviewed and analyzed.
A total of 796 children with HIV infection are registered in the Pediatric Immunodeficiency Clinic since January 1994. Among these, four children had arthritis, and it was the presenting manifestation in two of them. HLA-B27 related arthritis was noted in three children, while one had HIV-associated arthritis. None of the children had septic arthritis. Arthritis resolved on treatment with antiretroviral therapy (ART) in two children, while others responded to anti-inflammatory agents and the joint symptoms remained quiescent on follow-up with a total follow-up period of 21.5 patient years.
Clinicians must be aware of the arthritic presentation of childhood HIV infection. High degree of suspicion must be entertained to screen for HIV infection in children with arthritis, especially in those with reactive arthritis.
感染人类免疫缺陷病毒（HIV）的儿童通常会反复出现异常感染。虽然成人中也有相关报道，但关节炎作为HIV感染儿童的主要表现较为罕见。反应性关节炎被认为是成人HIV感染最常见的肌肉骨骼表现。然而，在儿童中，已描述过化脓性或HIV相关关节炎。我们报告了4例患有关节炎的HIV病患儿及其长期预后；其中3例患有人白细胞抗原（HLA）-B27相关关节炎。认识到儿童HIV病的关节炎表现对于防止诊断延误和启动适当治疗很重要。
对在昌迪加尔PGIMER儿科免疫缺陷诊所登记的患有关节炎的HIV感染儿童的临床资料进行回顾和分析。
自1994年1月以来，共有796例HIV感染儿童在儿科免疫缺陷诊所登记。其中，4例儿童患有关节炎，其中2例以此为首发表现。3例儿童被发现患有HLA - B27相关关节炎，1例患有HIV相关关节炎。所有儿童均无化脓性关节炎。2例儿童经抗逆转录病毒疗法（ART）治疗后关节炎缓解，其他儿童对抗炎药物有反应，随访期间关节症状保持静止，总随访期为21.5患者年。
临床医生必须认识到儿童HIV感染的关节炎表现。对于患有关节炎的儿童，尤其是患有反应性关节炎的儿童，必须高度怀疑以筛查HIV感染。
