Musculoskeletal considerations in HIV disease: A critical review

Introduction The vast progress in management of HIV disease with antiretroviral therapy (ART) in the past three decades has resulted in increased life expectancy for people living with HIV/AIDS. With this new chronicity of the disease has emerged a constellation of musculoskeletal impairments ranging from arthritis to traumatic fractures requiring orthopedic surgery. This manuscript aims to review and critique recent research (2009-2014) investigating musculoskeletal complications of HIV disease, and to propose future directions for management of such diagnoses. Methods The literature reviewed was divided into the following categories, in order of publication date: general musculoskeletal complications arising from the HIV virus itself and/or ART, HIV-related bone infections and bone disease, rheumatic disease in HIV infection, vitamin D deficiency in HIV disease, and orthopedic post-surgical complications/risk factors resulting from HIV disease. Results A total of 19 articles met the described inclusion criteria and were included in this critical review. From most recent (2014) to oldest (2009), 4 articles were published in 2014, 7 in 2013, 3 in 2012, 1 in 2011, 2 in 2010 and 2 in 2009. Discussion While the pathophysiology of HIV-related musculoskeletal complications is well documented in the literature, it is crucial that attention is also focused on treatment. The complex nature of disability in PLWHA necessitates a multidisciplinary approach to treatment to adequately address the diagnostic and treatment needs of this population. Conclusion Given the multitude of musculoskeletal complications that arise from the HIV virus and/or ART, research must be continuously conducted to assess risk, prevention and treatment. This research will need to focus on both nonsurgical and surgical approaches to management of musculoskeletal complications in the HIV-infected individual.