Prevalence and characteristics of articular manifestations in human immunodeficiency virus infection.

BACKGROUND Articular manifestations have been reported in HIV infection with a prevalence ranging from 2.5 to 68%. OBJECTIVES To determine the prevalence, types and characteristics of articular manifestations in the anti-retroviral treatment naive 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 One hundread and ninety three patients; 135 females and 58 males, aged between 19 to 65 years with Human immunodeficiency virus (HIV) infection who were naive to anti - retroviral drug therapy. MAIN OUTCOME MEASURE Presence of articular manifestations that included HIV associated arthritis, HIV associated spondyloarthropathies, HIV associated arthralgia, painful articular syndrome and avascular necrosis. RESULTS Thirty three of these 193 patients had articular manifestation with a prevalence of 17.1%. The type prevalence was; HIV associated arthralgia, 15.6%; undifferentiated spondyloarthropathy, 1% and HIV associated arthritis; 0.5%. Their mean age was 36 +/- 9 years, range 23-63 years; majority were female, male to female ratio of 1: 2.3 and the majority were in World health organization (WHO) clinical staging of HIV infection, class II and III with a mean CD4 cell count of 330 cells/mm3. Seventeen (51.5%) of the patients with articular disease had oligo - articular presentation, 10(30.3%) mono - articular while 6(18.2%) had poly - articular presentation. The mean duration of joint pains was 53.3 days (range of 2-365 days). Six (18.2%) of these 33 patients missed work, home making activities or school due to the articular disease. CONCLUSION Articular manifestations are common in HIV infection with a prevalence of 17.1%. HIV associated arthralgia was the most common manifestation. Majority of these patients were female, male to female ratio of 1: 2.3. The mean age of these patients was 36 years with a mean CD4 cell count of 330 cells/mm3 with 18.2% of them missing school or work.