Background/Purpose:  HIV infection has been associated with a plethora of rheumatologic diseases, however there are only few studies in the US analyzing the frequency of the different musculoskeletal conditions in patients with HIV on antiretroviral therapy (ART). The aim of the study was to calculate the proportion of rheumatic manifestations in HIV-infected patients who were receiving antiretroviral treatment and to identify association of the HIV medications with the development of rheumatologic conditions.

Methods:  We conducted a review of our electronic medical record database at Maricopa Integrated Health System during the period of 2009 to 2015 using ICD-9 and ICD-10 codes for specific morbidities. We identified 2,996 patients as having chronic HIV infection and on ART that had more than 2 visits in the HIV clinic. A chart review was performed and we identified patients with rheumatologic diseases based on the ACR and EULAR diagnostic criteria. We collected data regarding patient’s demographic characteristics, co-morbidities, CD 4 count, HIV viral load and antiretroviral regimen. One hundred fifteen patients with one of the morbidities and 200 randomly selected HIV-infected patients on ART without a diagnosis of rheumatologic disease were used for the analysis. Analytical comparison was based on an aggregate group of patients with any of the four morbidities: autoimmune conditions, avascular necrosis (AVN), musculoskeletal infections, or crystal arthropathies. Group differences were statistically compared and presented using Mann-Whitney U and Fisher’s exact test.

Results:  Based on the medical record review, 115 out of 2996 HIV patients (3.8%) were found to have a rheumatic condition (mean age of 48.6 years, 83% male). The most frequent musculoskeletal condition was AVN in 39 (1.3%) and the most frequent autoimmune condition was psoriasis in 28 patients (1%). Seven patients had rheumatoid arthritis (0.23%), 6 (0.2%) had psoriatic arthritis and 6 (0.2%) had systemic lupus erythematosus. Ankylosing spondylitis, granulomatosis with polyangiitis and polymyositis were present in one case each. Ten patient were diagnosed with gout (0.35%) and 1 patient had pseudogout. Infectious musculoskeletal conditions were present in 15 patients (0.5%), 12 with osteomyelitis and 3 with septic arthritis. Compared with the 200 HIV patients without any diagnosis of rheumatic disease, the patients with rheumatic conditions were older (median age of 50 vs. 42 years; p<0.01) and had a longer duration of HIV infection (median duration of 16 vs. 8 years; p<0.01). Those who received integrase inhibitors were more likely (63.3%) to develop rheumatologic manifestations relative to those who never received integrase inhibitors (21.6%; p<0.01).

Conclusion:  Our study showed that AVN is the most frequent rheumatic complication. Psoriasis was the most frequent autoimmune disease. The proportion of autoimmune rheumatic diseases in HIV patients appears to be comparable to the prevalence in the US population. Older age, longer duration of HIV infection and the use of ART regimens containing integrase inhibitors, appear to increase the risk of developing a rheumatologic condition.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/rheumatologic-diseases-in-hiv-infected-patients-in-the-post-antiretroviral-therapy-era-the-county-experience/