Saigal Renu, Chakraborty Avik, Yadav Ram Narayan, Goyal Laxmi Kant
Department of Medicine, JNU IMSRC Medical College, Jaipur, India.
Department of Medicine, TMC and Dr. BRAM Teaching Hospital, Hapania, Agartala, India.
Adv Ther. 2020 Oct;37(10):4336-4345. doi: 10.1007/s12325-020-01470-3. Epub 2020 Aug 24.
Rheumatological manifestations (RM) are very common in human immunodeficiency virus (HIV)-infected patients. The aim of this study was to determine the clinical spectrum of musculoskeletal involvement and relationship with the Centers for Disease Control and Prevention (CDC) stage and CD4+ cells and other factors.
A cross-sectional study was conducted involving 75 patients of over 18 years of either sex with confirmed HIV status attending a tertiary care hospital in north India in one calendar year. Baseline demographic details, relevant history including duration of combination antiretroviral therapy (cART), RM, joints involved, CD4 cell count, and biochemical parameters were evaluated.
Of 75 patients, 54 were male and 21 were female (mean age 33.15 ± 5.00 years, range 21-48 years). Most common RM was arthralgia (26.67%), followed by myalgia (18.67%), and arthritis (13.33%). Keratoderma blennorrhagicum (1.33%), tendo-achilles tendinitis (2.67%), and plantar fasciitis (2.67%) were other manifestations. Spondyloarthritis (SpA) was seen in 8% patients (undifferentiated SpA 4%, reactive arthritis 2.67%, psoriatic arthritis 1.67%). HIV-associated arthritis was seen in 2.67% while septic arthritis, rheumatoid arthritis, vasculitis, and diffuse infiltrative lymphocytic syndrome were seen in one patient (1.33%) each. The mean duration of disease in patients with RM was significantly less than patients without RM (p < 0.01). The erythrocyte sedimentation rate in patients with RM was significantly higher than in patients without RM (p < 0.05). Mean CD4 + cells were also significantly lower in patients with RM as compared to patients without RM (p < 0.05). Significantly fewer patients on cART had RM in comparison to patients not on cART (p < 0.001). Of 35 patients with RM, 25 were in CDC stage IV.
RM are common in HIV-infected patients. HIV arthralgia, myalgia, and undifferentiated SpA are the common manifestations. RM were associated with low CD4 counts. Most of the cases with RM were in CDC stage IV.
风湿性表现（RM）在人类免疫缺陷病毒（HIV）感染患者中非常常见。本研究的目的是确定肌肉骨骼受累的临床谱及其与美国疾病控制与预防中心（CDC）分期、CD4+细胞及其他因素的关系。
进行了一项横断面研究，纳入了在印度北部一家三级医院就诊的75例年龄超过18岁、HIV感染状态确诊的患者，性别不限，时间跨度为一个日历年。评估了基线人口统计学细节、相关病史，包括联合抗逆转录病毒治疗（cART）的持续时间、RM、受累关节、CD4细胞计数及生化参数。
75例患者中，男性54例，女性21例（平均年龄33.15±5.00岁，范围21 - 48岁）。最常见的RM是关节痛（26.67%），其次是肌痛（18.67%）和关节炎（13.33%）。溢脓性皮肤角化病（1.33%）、跟腱炎（2.67%）和足底筋膜炎（2.67%）是其他表现。8%的患者出现脊柱关节炎（SpA）（未分化SpA 4%，反应性关节炎2.67%，银屑病关节炎1.67%）。2.67%的患者出现HIV相关性关节炎，而脓毒性关节炎、类风湿关节炎、血管炎和弥漫性浸润性淋巴细胞综合征在各1例患者中出现（1.33%）。有RM的患者疾病平均持续时间显著短于无RM的患者（p<0.01）。有RM的患者红细胞沉降率显著高于无RM的患者（p<0.05）。与无RM的患者相比，有RM的患者平均CD4+细胞也显著更低（p<0.05）。与未接受cART的患者相比，接受cART的患者中出现RM的显著更少（p<0.001）。在35例有RM的患者中，25例处于CDC IV期。
RM在HIV感染患者中很常见。HIV关节痛、肌痛和未分化SpA是常见表现。RM与低CD4计数相关。大多数有RM的病例处于CDC IV期。
