Fort Beaufort Provincial Hospital, Amathole District, Eastern Cape, South Africa.
Division of Paediatric Rheumatology, Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Cape Town, South Africa.
Front Immunol. 2021 Jul 20;12:677984. doi: 10.3389/fimmu.2021.677984. eCollection 2021.
HIV infection has been associated with a non-erosive inflammatory arthritis in children, although few published reports exist. This study describes the clinical, laboratory and imaging features of this noncommunicable disease in a series of HIV-infected children in South Africa.
A database search was conducted to identify HIV-infected children enrolled in a Paediatric Rheumatology service in Cape Town, South Africa between 1 January 2010 and 31 December 2020. Retrospective data were collected from individuals classified with HIV arthropathy, based on a predefined checklist. Demographic, clinical, laboratory, sonographic, therapeutic, and outcomes data were extracted by chart review. Descriptive statistical analysis was performed using R (v4.0.3).
Eleven cases of HIV arthropathy were included in the analysis. Cases predominantly presented in older boys with low CD4+ counts. Median age at arthritis onset was 10.3 years (IQR 6.9 - 11.6) and the male-female ratio was 3.0. The median absolute CD4+ count was 389 cells/uL (IQR 322 - 449). The clinical presentation was variable, with both oligoarthritis and polyarthritis being common. Elevated acute phase reactants were the most consistent laboratory feature, with a median ESR of 126 mL/h (IQR 67 - 136) and median CRP of 36 mg/L (IQR 25 - 68). Ultrasonography demonstrated joint effusions and synovial hypertrophy. Response to therapy was slower than has generally been described in adults, with almost all cases requiring more than one immunosuppressive agent. Five children were discharged in established remission after discontinuing immunotherapy, however outcomes data were incomplete for the remaining six cases.
In this case series, HIV arthropathy was associated with advanced immunosuppression. Therapeutic modalities included immunomodulators and antiretroviral therapy, which consistently induced disease remission although data were limited by a high rate of attrition. Prospective studies are needed to define and understand this HIV-associated noncommunicable disease.
HIV 感染与儿童非侵蚀性炎症性关节炎有关，尽管已有少量相关报告。本研究描述了南非一系列 HIV 感染儿童中这种非传染性疾病的临床、实验室和影像学特征。
对 2010 年 1 月 1 日至 2020 年 12 月 31 日期间在南非开普敦儿童风湿病科登记的 HIV 感染儿童进行数据库搜索，以确定符合 HIV 性关节炎的儿童。根据预定义的检查表，从个体中收集回顾性数据。通过图表审查提取人口统计学、临床、实验室、超声、治疗和结局数据。使用 R（v4.0.3）进行描述性统计分析。
本研究共纳入 11 例 HIV 性关节炎病例。这些病例主要表现为低 CD4+计数的年长男孩。关节炎发病时的中位年龄为 10.3 岁（IQR 6.9-11.6），男女比例为 3.0。中位绝对 CD4+计数为 389 个细胞/μL（IQR 322-449）。临床表现多种多样，寡关节炎和多关节炎均常见。升高的急性期反应物是最常见的实验室特征，中位 ESR 为 126 mL/h（IQR 67-136），中位 CRP 为 36 mg/L（IQR 25-68）。超声显示关节积液和滑膜增生。对治疗的反应比一般成人描述的要慢，几乎所有病例都需要一种以上的免疫抑制剂。5 例儿童在停止免疫治疗后进入稳定缓解期，但其余 6 例的结局数据不完整。
在本病例系列中，HIV 性关节炎与严重免疫抑制有关。治疗方法包括免疫调节剂和抗逆转录病毒治疗，尽管因失访率高而数据有限，但这些方法均能诱导疾病缓解。需要前瞻性研究来定义和理解这种与 HIV 相关的非传染性疾病。
