HIV in Children

HIV ARTHROPATHY

Dr. Ira Shah
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Last Updated : 1st September 2012

HIV


Several rheumatic diseases have been associated with human immunodeficiency virus (HIV) of which reactive and psoriatic arthritis are the commonest. Other autoimmune conditions associated with HIV include a Sjogren’s-like syndrome, polymyositis, vasculitis, and seronegative spondylarthropathies. The precise cause of these spondylarthropathies in HIV infection is still unclear, however demonstration of HIV antigen in the synovial membranes suggests a direct role of HIV in the pathogenesis of HIV-associated rheumatic disease.

The disease seems to be more pronounced with erosive disease and joint fusion in African blacks as compared to the whites. Also, it has been found that in western population, HIV associated spondylarthropathy occurs in late stages of HIV infection whereas in Africans, it may be the first manifestation of the disease. Also, in whites the CD4 cells are depressed whereas in Africans, the CD4 cells are generally preserved. In Indians, the disease presents in a similar way as the whites.

In whites, it has been observed that arthropathy may flare up with immunosuppression whereas in Africans with immunosuppression the arthropathy may go into remission. It may be likely that regional differences in the prevalence of HIV spondylarthropathy may be due to additional environmental factors or HLA setup of the patient (3, 4) as HLA B27 prevalence is more common in the whites.

References :


  1. Shah Ira. HIV Associated Arthropathy and Response to Antiretroviral Therapy in an HIV-1 Infected Child. J Pediatr Infect Dis. 2006; 1: 53-55
  2. Koranyi KI, Brady M, Stock K, Lucas P, Nahata MC. Pancreatitis in children infected with human immunodeficiency virus. Pediatr AIDS HIV Infect. 1996;7:261-265.
  3. Malin JK, Patel NG. Arthropathy and HIV infection. A muddle of mimicry. Postgrad Med. 1993;93:143-146, 149-150.
  4. Mijiyawa M, Oniankitan O, Khan MA. Spondylarthropathies in sub-Saharan Africa Curr Opin Rheumatol 2000;12:281-286.
HIV ARTHROPATHY
Dr. Ira Shah
Incharge Pediatric HIV and TB Clinic, B.J.Wadia Hospital for Children, Mumbai, India Consultant in Pediatric Infectious Diseases, Nanavati Hospital, Mumbai, India.