Joint Manifestations in HIV Infection: A Review

There is a diversity of literature on varying aspects of HIV. Central nervous system, cardio-pulmonary and abdominal complications affecting people living with HIV infection and AIDS.(PLWHA) have been extensively discussed in the literature. However, research has recently focused on how the disease affects the musculoskeletal system. It is necessary to focus among various joint manifestations in order to diagnose and properly treat various orthopedic, rheumatologic and pain symptoms amongst PLWHA. Musculoskeletal manifestations can occur at any phase of the infection but they are commonly seen in late phases. Theincidence of rheumatic manifestations in HIV infection was reported in about 4to 71.3% cases in different studies. Although musculoskeletal abnormalities in PLWHA are not as common as other systemic disorders but a wide variety of osseous, articular, muscular and soft tissue diseases may be seen. Many of these conditions are not specific for HIV infection and AIDS and can be seen in other forms of immunosuppression. However, I will be focusing only on joint disease in this review.

Epidemiology:

Studies show that musculoskeletal conditions affect 72% of HIVinfected individuals during their lifespan. In a prospective study of 74 consecutive HIV +ve patients clinical features of rheumatic manifestations were compared with 72 controls HIV –ve subjects with similar risk factors for HIV. HIV +ve group had more rheumatological manifestations than the HIV -ve group: arthralgias were found in 45%, arthritis in 10%, and Reiter’s syndrome in 8%. Thus, the study suggested that rheumatic manifestations more prevalent in HIV +ve patients.

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Prevalence and Risk Factors Associated with Adherence to Antiretroviral Therapy in HIV-Infected Adults in a Tertiary Care Hospital in Mexico

Introduction:

In Mexico, antiretroviral therapy (ART) coverage for human immunodeficiency virus (HIV) infection is about 85%; the aim is to achieve optimal and prolonged HIV-1 RNA viral load suppression, if possible to <50 copies/mL, and patient adherence is necessary . ART suppresses the HIV-1RNA viral load, leading to immunological recovery and clinical improvements . Success in achieving good outcomes relies on high levels of ART adherence: preferably 95% or more to suppress HIV replication, and 80% or more to protect the immune system.

The World Health Organization defines adherence as the degree to which people’s behavior taking medication, keeping on a diet, and changes in lifestyle corresponds with agreed recommendations from a health care provider. Poor adherence compromises health improvements and leads to the wastage of treatment resources that are already limited. Non-adherence to recommended therapies is a global problem and has been observed for all diseases, but adherence to ART differs among countries according to clinical, economic, and socio-demographic factors. A meta-analysis of 19 case-controlled studies found that adherence to ART was significantly lower in patients with adverse reactions to antiretroviral drugs than among those without them.

A cross-sectional study conducted in Barcelona, Spain, in 2002 used the simplified medication adherence questionnaire (SMAQ) to validate adherence and applied it to 3004 HIV-infected patients. The test consists of six questions and the study found a prevalence of ART adherence of 68% in that population . A study conducted in Mexico on 93 HIV-infected patients foundthat 43% of participants were nonadherent; however, factors associated with nonadherence were not evaluated. In our country, information about ART adherence, the impact that it has on HIV-infected patients, and the associated risk factors is still limited. The aim of this study was to determine the prevalence of ART adherence and the risk factors associated with nonadherence in this HIV-infected population.