Therapy Insight: The Changing Spectrum of Rheumatic Disease in HIV Infection

Rashmi M. Maganti; John D. Reveille; Frances M. Williams


Nat Clin Pract Rheumatol. 2008;4(8):428-438. 

In This Article

Summary and Introduction

HIV infection and AIDS have protean and multisystem manifestations throughout the various stages of infection. Progression from HIV infection to AIDS is associated with a gradual loss of immunocompetence and the occurrence of opportunistic infections and malignancies; it is also associated with immune dysregulation and persistent, prolonged immune activation that leads to autoimmune phenomena such as vasculitis and serological abnormalities. In people who are infected with HIV, the recognition of autoinflammatory disorders, their differentiation from infections or lymphoproliferative malignancies and their treatment using potentially immunosuppressive drugs is a challenging clinical scenario. The spectrum of rheumatologic diseases reported in HIV-infected individuals has changed dramatically since the introduction of highly active antiretroviral therapy in 1995. Complications such as metabolic abnormalities, osteoporosis, and immune restoration inflammatory syndrome have emerged.

In the 26 years since the first reported cases of HIV infection, the disease has attained pandemic status, especially in sub-Saharan Africa and Central Asia. Therapeutic developments and improved utilization of public resources, however, mean that treatments are available to most patients, at least in the developed world. By the end of 2006, the Joint WHO–United Nations Programme on HIV and AIDS estimated that the number of people who were living with the virus globally was ~33.5 million, which represented a decrease from the estimates of previous years.[1] This reduction in estimated numbers is partly caused by genuine declines in HIV prevalence in several countries. In addition to the declining prevalence of HIV, the number of deaths from AIDS is also thought to have fallen from approximately 3.1 million in 2005 to 2.9 million in 2006.[1] As mortality from AIDS decreases, the morbidity associated with chronic conditions (and their treatment) in HIV-infected individuals becomes increasingly apparent, and rheumatic diseases, therefore, are encountered increasingly often in this population. Since the first reports of rheumatic disease in HIV-positive patients in the 1980s,[2] the spectrum of rheumatic conditions associated with HIV and AIDS has evolved, especially with the introduction of highly active antiretroviral therapy (HAART).