Prevalence of articular manifestations in Human Imunodeficiency Virus Type -1 Infection

Abstract

Introduction: Articular manifestations have been reported in HIV infection with a prevalence ranging from 2.5 to 68%. The manifestations include, spondyloarthropathies (reactive arthritis, psoriatic arthritis and undifferentiated spondyloarthropathy), painful articular syndrome, HIV associated arthritis, arthralgia and avascular necrosis. No studies had been done locally. Objective: To determine the prevalence and types of articular manifestations in the HIV infected patients. Design: Cross sectional descriptive study. Setting: Comprehensive care clinic (HIV outpatient clinic) at the Kenyatta National Hospital (KNH) from October 2007 to March 2008. Subjects: 193 patients with HIV/AIDS infection. Methodology: A sample of 214 patients with HIV/AIDS infection was Consecutively interviewed. 21 patients were excluded. 193 patients were recruited, interviewed and examined as per the gait, arms, spine, and legs (GALS) locomotor screen. Those with abnormal GALS screen were further interviewed and examined as per the American College of Rheumatology Ad hoc committee on clinical guidelines, guidelines for the initial evaluation of adults with acute musculoskeletal symptoms. All patients with articular disorders had there global functional status assessed All the study patients had blood drawn for total blood count, erythrocyte sedimentation rate (ESR) and CD4 cell count determination, additional uric acid, rheumatoid factor and antinuclear antibody tests were carried out for patients with arthritis. Patients who had hip and alternating buttock pains had plain radiographs of the hip and sacroiliac joints done and plain. radiographs evaluated for features of avascular necrosis and sacroillitis respectively. Results: The prevalence of articular manifestations was 17.1% (12.1-22.1 %), . with a type prevalence of; HIV associated arthralgia: 15.6% (10.5-20.7%), undifferentiated spondyloarthropathy: 1%, HIV associated arthritis 0.5%. There was no association between CD4 cell count and articular manifestations (p=0.459). 48.5% of those with articular disease had functional impairment. Conclusion: Articular disease in HIV infection is common and is a cause of morbidity.There was no association between the articular diseases and CD4 cell count.