Musculoskeletal Disorders Are Often Associated With HIV Infection

People with HIV often experience a wide array of musculoskeletal symptoms secondary to HIV infection. Some studies have shown that approximately 70 percent of HIV patients had bone, joint, or muscle involvement. These musculoskeletal diseases can be a direct effect of the virus or a part of the opportunistic infections that occur in HIV patients because of the weakened immune system.

Ayaz A. Baviji, M.D., and colleagues reviewed the research studying muscle, bone and joint disorders in HIV patients, summarizing their findings in the report "Musculoskeletal Manifestations of Human Immunodeficiency Virus Infection" published in the Journal of the American Academy of Orthopaedic Surgeons (2002;10(5)). Although musculoskeletal involvement may occur at any phase of HIV infection, it more commonly develops in later stages. Nevertheless, 50-70 percent of HIV patients complain of muscle and joint pain at early stages of HIV infection. Therefore, HIV infection should be considered if there is a sudden onset of muscle and joint pain in individuals who have been exposed to HIV.

Muscle disease processes experienced by HIV patients can be inflammatory, infectious, or related to tumor growth. An inflammation of a voluntary muscle (myositis), for example, may be the first symptom of HIV. Other muscle diseases may result from drug-induced effects of HIV drugs, primarily azidothymidine (AZT), or direct invasion of muscle tissue by HIV.

Beginning as a lung infection, TB may spread to the skeletal structure; one study showed that the disease involved the spine in 66 percent of the cases studied, the hip in 18 percent, the knee in 10 percent, other joints in 5 percent, and other bones in 1 percent.

HIV-associated arthritis, swollen or painful joints, and Reiter's syndrome are more likely to afflict HIV-positive than HIV-negative persons. Neoplastic, or tumor-causing, conditions are other disorders prevalent in HIV patients as the immune system deteriorates. Non-Hodgkin lymphoma, for example, is the second most common type of tumor in HIV patients after Kaposi sarcoma and is 60 times more prevalent among HIV patients than in the general population.

HIV patients with musculoskeletal symptoms can be a diagnostic and treatment challenge for orthopedic surgeons, who must not only manage the symptoms of these patients but also be aware of the outcomes and risks of HIV patients during either emergency or elective orthopedic surgery. Bone and soft-tissue healing as well as resistance to infection may be impaired in individuals with weakened immune systems. Orthopedic surgeons should perform a thorough preoperative evaluation, including assessment of the patient's immune system, before surgery. Biviji and colleagues recommend a multidisciplinary approach to treating HIV patients, especially for surgeons who do not routinely treat such individuals. The researchers also highly recommend HIV testing in patients with unusual musculoskeletal complaints who are at risk for or have been exposed to HIV.

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