Rheumatic manifestations among HIV positive adults attending the Infectious Disease Clinic at Mulago hospital

Background: Rheumatic manifestations in HIV are common and sometimes the initial presentation of the disease. HIV is now a common infection at the Infectious Disease Clinic, Mulago. The spectrum of joint diseases seen depend on a number of factors such as, the CD4 count, HLA status and current therapy. Objective: This study included HIV patients from a heterogeneous population and was designed to determine the prevalence and clinical pattern of rheumatic manifestations among these HIV patients. Methods: Four hundred eighty seven patients were screened and 300 HIV positive patients were consecutively recruited into the study, evaluated for rheumatic manifestations and their clinical and laboratory findings documented. Results: The prevalence of rheumatic manifestations was 27% (81 of 300). Arthralgias in 19.3% of the study population were commonest finding followed by HIV associated arthritis at 4.3%. The lower limbs were the most commonly affected with the knees (28.8%) and ankles (26.9%) contributing the highest. All patients had a negative anti-nuclear antibody test, with only two having a positive rheumatoid factor test. An association of antituberculosis drugs with joint disease was further highlighted in this study (OR 3.79 95% CI, 1.44 - 9.93). Septic arthritis due to Staphylococcus aureus was rarely observed except when the patients' level of CD4 + T cells dropped below 200 cells mm³. The mean CD4+ count was 171 cells mm³. Conclusion: Rheumatic manifestations should be considered among HIV positive adults. Arthralgias are common especially in patients using pyrazinamide.