Rheumatic manifestations in populations at risk for HIV infection: the added effect of HIV.

We assessed the frequency and variability of rheumatologic manifestations in 2 populations with similar risk factors for human immunodeficiency virus (HIV) infection, of which only one was affected. We studied 2 populations at risk for HIV infection (homosexual and intravenous drug users). Group A: 89 individuals carried the virus; and Group B: 80 individuals were HIV negative. In Group A (HIV+) 66.1% had rheumatic manifestations including arthralgias, Reiter's syndrome, arthritis, enthesitis, psoriatic arthritis, Sj?gren's syndrome, myopathy, septic arthritis, and lupus-like illness. In contrast, in Group B (HIV-) only 2 had arthralgias, 2 Reiter's syndrome, and 1 rheumatoid arthritis. In summary, rheumatic complaints are common in patients with HIV, and HIV positivity confers an increased susceptibility in populations with similar risk factors for HIV infection.     

Rheumatic manifestations of human immunodeficiency virus infection

PURPOSE: The prevalence and characteristics of the rheumatic and extra-rheumatic manifestations of human immunodeficiency virus (HIV) infection were determined in a prospective manner. PATIENTS AND METHODS: One hundred one patients with HIV infection were consecutively interviewed and examined. The prevalence of autoantibodies and their association with rheumatologic symptoms were also determined. RESULTS: The musculoskeletal system was involved in 72 patients. Thirty-five patients had arthralgias, 10 had Reiter's syndrome, two had psoriatic arthritis, two had myositis, and one had vasculitis. Also found were two previously unreported syndromes. The first, occurring in 10 patients, consisted of severe intermittent pain involving less than four joints, without evidence of synovitis, of short duration (two to 24 hours), and requiring therapy (ranging from nonsteroidal antiinflammatory drugs to narcotics). The second, occurring in 12 patients, consisted of arthritis (oligoarticular in six patients, monoarticular in three patients, and polyarticular in three patients) involving the lower extremities and lasting from one week to six months. The synovial fluid of five patients (three with arthritis, one with Reiter's syndrome, and one with psoriatic arthritis) was sterile and inflammatory. CONCLUSION: Musculoskeletal complications are common in advanced stages of HIV infection. Persons in a high-risk group for HIV infection who manifest oligoarthritis with or without any other extra-articular manifestation suggestive of Reiter's syndrome or other form of spondyloarthropathy should be tested for HIV.     

Rheumatic symptoms and human immunodeficiency virus infection. The influence of clinical and laboratory variables in a longitudinal cohort study

The present study was designed to prospectively evaluate the frequency of rheumatic symptoms in a cohort of patients infected with the human immunodeficiency virus (HIV), to examine the relationship between such findings and a variety of clinical and epidemiologic variables, and to evaluate the impact of rheumatic symptoms on the natural history of the HIV infection. One hundred seventeen patients were evaluated over a mean of 24.6 months (range 0.5-85 months). Cumulatively, 1.7% had Reiter's syndrome, 1.7% had psoriatic arthritis, and 11.1% had various forms of oligoarticular/monarticular or polyarticular arthritis. The majority of the rheumatic symptoms developed during the longitudinal evaluation and predominantly affected patients with clinically advanced HIV infection. Patients with articular disease tended to have more progressive HIV infection and were more likely to experience disease progression to clinical acquired immunodeficiency syndrome or death. Our data suggest that the occurrence of rheumatic symptoms in the presence of HIV infection is not uncommon and tends to develop over time, in the setting of clinically advanced retroviral infection. Furthermore, the presence of rheumatic symptoms may be a sign of a poor prognosis for patients with HIV infection.     

Human immunodeficiency virus infection associated arthritis: clinical characteristics.

OBJECTIVE: To define the frequency and characteristics of human immunodeficiency virus (HIV) associated arthritis. METHODS: A total of 270 patients with HIV infection were prospectively evaluated for the presence of rheumatic complaints. Diagnosis of HIV infection was performed by ELISA and confirmed by Western blot, and all HIV patients were classified according to the US Centers for Disease Control criteria. RESULTS: Twenty-one (7.8%) patients presented with HIV associated arthritis. Other arthritides including HLA-B27 related, such as Reiter's syndrome, psoriatic arthritis, and rheumatoid arthritis, were excluded. Seventeen were men and 4 women, with a mean age of 34.8 years (SD 11.1). Fourteen (66%) were homosexuals, 4 (19%) intravenous drug users, and 3 (14%) heterosexuals. Twelve (57%) were in stage IV, 5 (23%) in stage III, and 4 (9%) in stage II. Ten (47%) patients had oligoarticular involvement, 8 (38%) monoarticular, 2 (9%) asymmetric polyarthritis, and one (4%) symmetric polyarthritis. Rheumatoid factor and HLA-B27 antigen were negative in all (15) patients studied. The mean duration of arthritis was 2 weeks (1-24). No differences in duration of arthritis were found among the different risk factors (p = 0.811), HIV stages (p = 0.205), and type of articular involvement (p = 0.252). There was, however, a trend between the number of involved joints and stages of HIV infection (p = 0.13). CONCLUSION: The pattern of joint involvement of HIV associated arthritis is similar to that of other viral disorders: acute onset, short duration, no recurrences, and no erosive changes.     

The changing spectrum of rheumatic disease in human immunodeficiency virus infection

CONTEXT: Although it has been known for over 15 years that a number of rheumatic diseases occur in patients with human immunodeficiency virus (HIV) infection, increasing knowledge about these disorders and advances in HIV treatment need to be considered in approaching patients with HIV-associated rheumatic disease. OBJECTIVE: To examine the clinical, pathologic, and therapeutic features of HIV-associated rheumatic diseases in the context of what is known about the immunology of HIV infection. DATA SOURCES: The author's own extensive collection of references, supplemented by PubMed Medline searches for articles in English-language journals published between 1985 and 2000. The indexing term HIV and the following coindexing terms were used for searching: arthritis, Reiter's syndrome, psoriatic arthritis, rheumatoid arthritis, osteonecrosis, vasculitis, pulmonary hypertension, myositis, myopathy, fibromyalgia, septic arthritis, parotid enlargement, diffuse infiltrative lymphocytosis syndrome, systemic lupus erythematosus, septic arthritis, mycobacterial arthritis, fungal arthritis, autoantibodies, anti-cardiolipin antibodies, and anti-neutrophilic cytoplasmic antibodies. STUDY SELECTION: All papers identified in the literature search were reviewed. Studies presenting data that merely confirmed previous studies were not included in the analysis. DATA EXTRACTION: All identified papers were abstracted by the author. Letters to the editor were included only if a new observation had been made. DATA SYNTHESIS: This was a qualitative review of papers published, with new knowledge about these disorders summarized and presented. RESULTS: Despite new treatments for HIV, reports of rheumatic diseases presenting in AIDS patients persist, especially in HIV-associated arthritis, diffuse infiltrative lymphocytosis syndrome, HIV-associated vasculitis, and polymyositis. However, new HIV treatments may ameliorate these diseases. CONCLUSIONS: The spectrum of HIV-associated rheumatic disease remains a diagnostic and therapeutic challenge for the clinician. The impact of changes in HIV treatment on these disorders requires further assessment.     

Jaccoud arthropathy: a rarity in the spectrum of HIV-associated arthropathy

In studies comparing HIV-infected patients with HIV-negative patients, rheumatic manifestations, including reactive arthritis, psoriatic arthritis, myalgia, tendinitis, fibromyalgia, necrotizing vasculitis, polymyositis, Sjogren syndrome, were shown to occur more frequently in the HIV-positive group. Uncommon clinical features and the demonstration of HIV antigens in the synovial membranes suggest a direct role of HIV in the pathogenesis of HIV-associated rheumatic disease. Jaccoud arthropathy is a nonerosive deforming arthropathy reported to occur in cases of chronic rheumatic fever and systemic lupus erythematosus. Only two cases of HIV-associated Jaccoud arthropathy has been reported in the literature thus far, both in patients with features of reactive arthritis. We report a case of HIV-associated Jaccoud arthropathy in a patient without features of reactive arthropathy.     

Rheumatic manifestations in 556 patients with human immunodeficiency virus infection

We studied in retrospect the rheumatic manifestations of 556 patients with human immunodeficiency virus (HIV) infection. Eighty percent were men. Eighty-six percent were intravenous drug abusers (IVDAs), 9% homosexual, 3% partners of high-risk persons having the infection, 0.4% hemophiliacs, and 2% had no known risk factors. We found rheumatic disorders in 63 (11%) patients. The most frequent findings were myalgias and/or arthralgias (4.5%; one patient had an inflammatory myopathy), skeletal infections (3.6%), and arthralgias (1.6%). Reiter's syndrome and seronegative arthritis were present only in 0.5%, and HIV-associated arthritis and vasculitis in 0.4%, respectively. Skeletal infections were caused predominantly by Staphylococcus aureus (60%) and Candida albicans (20%). All these patients were IV drug abusers whose clinical features were similar to those previously described in skeletal infections of non-HIV-infected IVDAs. Comparing these data with other studies composed primarily of homosexual men where Reiter's syndrome is the predominant rheumatic disorder, we conclude that the type of rheumatic complaint is more related to the risk factors than to HIV itself.     

AIDS and rheumatic manifestations in patients addicted to drugs. An analysis of 106 cases

We evaluated the rheumatic manifestations in 106 patients with AIDS whose risk factor is intravenous drug addiction. All were intravenous drug addicts and carriers of the human immunodeficiency virus (HIV). Their average age was 28.36 years; 83 were men and 23 were women; 73 were in stage IV of the HIV infection; 12 were in stage III and 21 in stage II. Rheumatic manifestations were found in 21 patients (20%). Specifically, 13 had arthralgias/myalgias, 2 demonstrated oligoarthritis, 1 had tuberculous arthritis of the knee, and 1 patient showed systemic necrotizing vasculitis. Finally, 6 patients had a history of septic arthritis. There was an absence of the Reiter syndrome/reactive arthritis, a low frequency of symptoms of articular swelling, and the marked presence of histories of septic arthritis. The practices that lead to HIV infection may play a decisive role in the appearance of rheumatic manifestations in patients with AIDS, even more than the presence of the virus itself or the immunological alterations thereby produced.     

Distinctive rheumatic manifestations in 98 patients with human immunodeficiency virus infection in China

OBJECTIVE: To analyze the spectrum and risk factors of rheumatic manifestations in patients with human immunodeficiency virus (HIV) infection. METHODS: Ninety-eight consecutive inpatients with HIV infection admitted to Peking Union Medical College Hospital from 1999 to 2006 were studied. Demographic data, routes of transmission, clinical features, and laboratory findings were collected and a database was established. Laboratory studies included blood CD3+, CD4+, CD8+, CD19+, CD16+CD3+, CD4+CD28+, CD8+CD28+, HLA- DR+CD8+, and CD8+CD38+ lymphocyte counts, and antinuclear antibody tests. Hepatitis C virus (HCV) infection was also investigated in each patient. Risk factors for the rheumatic manifestations of HIV infection were assessed by logistic regression analysis. RESULTS: Rheumatic manifestations were found in 53 (54.08%) HIV patients. Vasculitis was the most common finding (20 cases; 20.41%), including 15 cases of Beh?et-like disease, 2 cases each of Henoch-Sch?nlein purpura and digital gangrene, and one case of central nervous system vasculitis. Other common rheumatic manifestations included Sj?gren-like syndrome/diffuse infiltrative lymphocytosis syndrome (DILS; 11 cases; 11.22%), lupus-like syndrome (10 cases; 10.20%), of which 5 cases had renal involvement, and myositis (8 cases; 8.16%) including one case of zidovudine-induced myositis. No case of spondyloarthropathy was observed. Logistic regression analysis showed that Centers for Disease Control CD4+ T cell staging, erythrocyte sedimentation rate, and HCV infection were risk factors for HIV patients to develop rheumatic manifestations [p = 0.01, odds ratio (OR) = 31.80; p = 0.02, OR = 2.93; p = 0.01, OR = 17.47, respectively]. CONCLUSION: Rheumatic disorders such as vasculitis, Sj?gren-like syndrome/DILS, lupus-like syndrome, and myositis were common in Chinese patients with HIV, while articular disorders were rare. CD4+ T cell depletion and HCV coinfection may predispose patients with HIV to develop rheumatic manifestations.     

There is an association between human immunodeficiency virus infection and spondyloarthropathies.

The presence of inflammatory musculoskeletal manifestations during the course of human immunodeficiency virus (HIV) infection is well established. A wide spectrum of rheumatic disorders have been reported since the first reports of Reiter's syndrome with HIV infection. Other reported associations include forms of arthropathies, psoriatic arthritis, Sj?gren's syndrome, polymyositis-dermatomyositis, vasculitis, and septic arthritis.     

Rheumatologic manifestations of infection with the human immunodeficiency virus (HIV)

The aim of this study was to assess the type and frequency of rheumatologic manifestations among patients followed at an HIV clinic in a general hospital, and to evaluate the usefulness of a questionnaire in identifying the presence of these manifestations. Fifty-two consecutive patients with HIV infection completed a questionnaire regarding the presence of rheumatologic symptoms. All patients were interviewed and examined for the prevalence and spectrum of musculoskeletal manifestations. The questionnaire was found to be sensitive in identifying patients with rheumatologic manifestations which were detected on clinical examination. The latter were found in 34 patients (65.3%). Twenty-one patients (40.3%) had arthralgias, 8 (15.2%) had spondyloarthropathies (including Reiter's syndrome, psoriatic arthritis and undifferentiated spondyloarthropathy). Two patients (3.8%) had oligoarthritis and one case each had myositis, Sj?gren's syndrome and Beh?et's syndrome. Muscle pain was common, occurring in 35% of the patients, and it was related to the use of zidovudine therapy. In contrast to previous reports, most of the patients with arthritis had mild disease, responding promptly to non-steroidal anti-inflammatory drugs. This difference may be explained by the use of zidovudine therapy, stage of HIV infection, and lifestyle. A questionnaire may be helpful in identifying the prevalence of rheumatologic manifestations in HIV-infected subjects.     

Tuberculous meningitis in patients with and without human immunodeficiency virus infection.

OBJECTIVE: To characterize the symptoms, signs, laboratory findings, and outcome of culture-proven meningitis due to Mycobacterium tuberculosis in patients with and without human immunodeficiency virus (HIV) infection. DESIGN: Retrospective chart review. SETTING: Urban public general hospital in the United States. PATIENTS: Fifteen patients with and 16 without HIV infection. MEASUREMENTS: Demographics, symptoms, physical exam findings, serum sodium, complete blood cell count, CD4+ cell count, cerebrospinal fluid findings, imaging data, and in-hospital mortality. MAIN RESULTS: Symptoms, signs, chest radiograph appearance, cerebrospinal fluid cell counts and chemistries, and mortality were similar in both groups (p = NS). Median CD4+ cell counts were lower in HIV-infected patients (median 99/mm3, range 7 to 251, versus 384/mm3, range 171 to 724 in those without HIV infection, p = 0.007). Intracerebral mass lesions were more common in the HIV-infected group (60% versus 14% in the uninfected group, p = 0.01), although the presence of a mass did not correlate with focal neurologic deficits, altered level of consciousness, or mortality. CONCLUSION: With the exception of an increased incidence of intracerebral mass lesions in HIV-infected individuals, HIV infection appears to have little impact on the findings and in-hospital mortality of tuberculous meningitis.     

Prolonged arthritis associated with sindbis-related (Pogosta) virus infection

OBJECTIVE: A follow-up study of musculoskeletal symptoms after Pogosta virus infection. METHODS: Twenty-six patients with earlier serologically confirmed Pogosta disease were examined. Ultrasonography of affected joints was performed in patients who had chronic musculoskeletal symptoms. Serum antibodies against Sindbis virus were determined. The patients were typed for HLA-DR and B27. Efforts were made using the polymerase chain reaction to demonstrate the virus. RESULTS: Only 50% of the patients were symptomless 2.5 yr after onset of Pogosta disease. Three patients had fibromyalgia, six had occasional arthralgia and two had chronic arthritis. CONCLUSIONS: The epidemiology of Pogosta disease is changing and practitioners should be better aware of it. Pogosta virus infection may lead to chronic musculoskeletal discomfort and arthritis.     

Functional and structural markers of atherosclerosis in human immunodeficiency virus-infected patients.

OBJECTIVES: We investigated functional and structural markers of atherosclerosis in human immunodeficiency virus (HIV)-infected patients in relation to the presence of the metabolic syndrome (MS). BACKGROUND: Antiretroviral combination therapy in HIV has been associated with cardiovascular risk factors that cluster in the MS. METHODS: Thirty-seven HIV-infected patients underwent assessment of flow-mediated vasodilation (FMD), aortic pulse-wave velocity (PWV), and carotid intima-media thickness (IMT). Age-matched type 2 diabetic patients (n = 13) and healthy controls (n = 14) served as reference groups. RESULTS: Fifteen HIV-infected patients (41%) fulfilled the National Cholesterol Education Program criteria of the MS. The FMD was similarly impaired in HIV-infected patients without the MS (MS- group) and the diabetic patients (5.1 +/- 0.4% and 4.9 +/- 0.6%, respectively) compared with controls (8.8 +/- 0.7%). The HIV-infected patients with the MS (MS+ group) had even more impaired FMD (2.5 +/- 0.3%). Carotid IMT was similarly increased in the MS+ group and the diabetic patients compared with the other groups. Aortic PWV was increased in the diabetic patients only. In HIV-infected patients, FMD was related to metabolic parameters, whereas aortic PWV and IMT were related to parameters of HIV infection, time on antiretroviral combination therapy, inflammatory (C-reactive protein and leukocytes) and metabolic parameters. CONCLUSIONS: The data of the present study suggest an increased cardiovascular risk in HIV-infected patients, even in the absence of clustering of metabolic risk variables. The presence of the MS in HIV is associated with even more advanced atherosclerotic changes. Presumably, both HIV infection and antiretroviral therapy may promote atherosclerosis through mechanisms involving endothelial cells, either directly or indirectly via metabolic risk factors.     

Rheumatic complications of human immunodeficiency virus infection in the era of highly active antiretroviral therapy: emergence of a new syndrome of immune reconstitution and changing patterns of disease

OBJECTIVE: To describe the impact of the introduction of highly active antiretroviral therapy (HAART) on the nature and frequency of rheumatic complications in human immunodeficiency virus (HIV)-infected patients. METHODS: Case report and systematic review of a newly described syndrome of rheumatic immune reconstitution syndrome and prospective longitudinal cohort study analyzing the frequency and nature of rheumatic complications in the setting of HIV infection from 1989 through 2000. RESULTS: A newly described syndrome of either the de novo appearance or the exacerbation of clinically occult autoimmunity following immune reconstitution from HAART is described. Including the present case report, 32 cases have been individually described with sarcoidosis and autoimmune thyroid disease being most common with arthritis and various forms of connective tissue disease making up the rest. The mean onset to their appearance following HAART was nearly 9 months and most resolved with little or no therapy. In addition, a longitudinal analysis of 395 HIV-infected patients from 1989 to 2000 designed to detect the appearance of rheumatic complications has revealed a dramatic decline in certain problems such as reactive arthritis, psoriatic arthritis, and various forms of connective tissue disease. New rheumatic complications possibly due to the effects of longer survival and metabolic derangements associated with this form of therapy are now being described and may become more formidable problems in this population in the future. CONCLUSIONS: HAART has had a profound beneficial effect on survival in HIV-infected patients but has also contributed to both an altered frequency and a different nature of rheumatic complications now being observed in this population. Rheumatologists need to be aware of these changes to provide optimal diagnosis and treatment for this group.     

Various rheumatic syndromes in adult patients associated with high antistreptolysin O titres and their differential diagnosis with rheumatic fever.

OBJECTIVES--The purpose of this study was to analyse retrospectively adult patients with acute joint or muscle symptoms and a high antistreptolysin O (ASO) titre to find out which syndromes of clinical arthritis are associated with serological evidence of streptococcal infection. METHODS--Seventy six adult patients with an acute arthritis syndrome or an exacerbation in their chronic rheumatic disease and simultaneously a high ASO titre (> or = 500 Todd units) were examined in two time periods in the 1980s. RESULTS--Twenty six patients had arthritis associated with a known rheumatic disease, 25 had non-specific arthralgia/myalgia, 20 had reactive arthritis, and five had septic arthritis. No case of classic rheumatic fever classified by two major criteria was found. Six patients fulfilled one major and at least two minor criteria. The frequency of HLA-B27 was significantly higher in the whole patient group than in the healthy Finnish population (30 v 14%). CONCLUSIONS--It is concluded that classic rheumatic fever is now rare, even in patients with arthritis with a high ASO titre. These results support the suggestion that beta haemolytic streptococci may trigger reactive arthritis as well as rheumatic fever.     

The epidemiology of HIV-associated tuberculosis in rural Cambodia.

SETTING: Banteay Meanchey Province, Cambodia. OBJECTIVE: The World Health Organization recommends human immunodeficiency virus (HIV) testing for all tuberculosis (TB) patients and TB screening for all HIV-infected persons in countries with a TB-HIV syndemic. We sought to determine whether evidence supports implementing these recommendations in South-East Asia. DESIGN: We conducted a cross-sectional survey and retrospective cohort study of patients newly diagnosed with HIV or TB from October 2003 to February 2005 to identify risk factors for HIV infection and TB, and for death during TB treatment. RESULTS: HIV infection was diagnosed in 216/574 (38%) TB patients. TB disease was found in 124/450 (24%) HIV-infected persons. No sub-groups of patients had a low risk of HIV infection or TB. Of 180 TB patients with HIV infection and a recorded treatment outcome, 49 (27%) died compared to 17/357 (5%) without HIV infection (relative risk [RR] 5.2, 95% confidence interval [CI] 3.1-8.7). HIV-infected TB patients with smear-negative pulmonary disease died less frequently than those with smear-positive pulmonary disease (RR 0.39, 95%CI 0.16-0.93). CONCLUSIONS: No sub-groups of patients had low risk for HIV infection or TB, and mortality among HIV-infected TB patients was high. These data justify using the WHO global TB-HIV recommendations in South-East Asia. Urgent interventions are needed to reduce the high mortality rate in HIV-infected TB patients.     

Psychological well-being in patients with primary Sjögren's syndrome

OBJECTIVES: To evaluate quality of life and psychological symptoms in patients with primary Sj?gren's syndrome and to compare this with patients with rheumatoid arthritis. METHODS: A standardised questionnaire, the Psychological General Well-Being Index (PGWB), was used to examine the quality of life and psychological symptoms in patients with primary Sj?gren's syndrome (pSS; n = 34). Patients with rheumatoid arthritis (RA; n = 32) were used as patient controls. RESULTS: The total mean score +/- SD for PGWB was 84.9 +/- 16.2 in pSS patients and significantly lower (p = 0.001) than in RA patients (97.7 +/- 17.5). Patients with pSS had an increased propensity for depressed mood (p = 0.0009), and suffered from reduced well-being (p = 0.002) and impaired vitality (p = 0.003). CONCLUSION: The results suggest that patients with pSS have a reduced quality of life, a higher degree of distress and a lower sense of well-being than patients with RA.     

Rheumatic conditions in human immunodeficiency virus infection

Many rheumatic diseases have been observed in HIV-infected persons. We, therefore, conducted a comprehensive literature search in order to review the prevalence, presentation and pathogenesis of rheumatic manifestations in HIV-infected subjects. Articular conditions (arthralgia, arthritis and SpAs) are either caused by the HIV infection itself, triggered by adaptive changes in the immune system, or secondary to microbial infections. Muscular symptoms may result from rhabdomyolysis, myositis or from side-effects of highly active anti-retroviral therapy (HAART). Osseous complications include osteonecrosis, osteoporosis and osteomyelitis. Some conditions such as the diffuse infiltrative lymphocytosis syndrome and sarcoidosis affect multiple organ systems. SLE may be observed but may be difficult to differentiate from HIV infection. Some anti-retroviral agents can precipitate hyperuricaemia and are associated with arthralgia. When indicated, immunosuppressants and even anti-TNF-alpha agents can be used in the carefully monitored HIV patient. Thus, rheumatic diseases and asymptomatic immune phenomena remain prevalent in HIV-infected persons even after the widespread implementation of highly active anti-retroviral therapy.     

Human immunodeficiency virus-associated rheumatic disorders in the HAART era

OBJECTIVE: To define the frequency and characteristics of human immunodeficiency virus (HIV)-associated rheumatic manifestations in patients receiving highly active antiretroviral therapy (HAART) referred to a rheumatology clinic. METHODS: A total of 75 patients with HIV infection receiving HAART were prospectively evaluated for the presence of rheumatic complaints. Diagnosis of HIV infection was performed by ELISA and confirmed by Western blot, and all HIV patients were classified according to the US Centers for Disease Control criteria. RESULTS: Seventy-five individuals with HIV infection and musculoskeletal manifestations were evaluated: 65 (86%) men and 10 (14%) women. Mean age was 32 +/- 4.5 years (range 21-58). The group included 40 (53%) heterosexuals, 30 (40%) intravenous drugs users, 9 (12%) homosexuals, 3 (4%) who had received blood transfusion, and 2 (2.6%) with unknown risk factors. Septic manifestations were the most common complications seen in 31 (41%) out of 75, and included septic arthritis, cellulitis, osteomyelitis, diskitis, and pyomyositis. Fibromyalgia was present in 13 (17%), seronegative symmetric polyarthritis in 4, oligoarthritis in 4, psoriatic arthritis in 2, carpal tunnel syndrome in 2, and enthesitis in 2. Mutifocal bone non-Hodgkin's lymphoma was present in 7 (9.3%) and Kaposis's sarcoma of bone in 2 (2.6%) patients. Hypertrophic osteoarthropathy in 3 (4%) and aseptic bone necrosis of multiple bones was seen in 3 (4%) patients. Ten patients exhibited only arthralgias. Most patients had moderately elevated erythrocyte sedimentation rate and C-reactive protein. Mean CD4 cell count was 250 mm3 (range 20-450), and mean HIV viral load was 5210 (range 0-75,300) copies/ml. CONCLUSION: Rheumatic manifestations were highly frequent in HIV patients receiving HAART referred to a rheumatology clinic, although the clinical spectrum differed from the pre-HAART era with septic and malignant complications being the most common manifestations seen.