Rheumatic diseases in HIV-infected patients in the post-antiretroviral therapy era: a tertiary care center experience

  • Konstantinos Parperis
  • Yasir Abdulqader
  • Robert Myers
  • Bikash Bhattarai
  • Muhsen Al-Ani
Original Article

Abstract

The aim of the study was to calculate the proportion of rheumatic diseases in HIV patients who were receiving ART and to identify association of the HIV medications with the development of rheumatologic diseases. We conducted a retrospective chart review during the period of 2010 to 2016. We identified 2996 patients as having chronic HIV infection and on ART, and we collected data regarding patient’s demographic characteristics, comorbidities, CD 4 count, HIV viral load, and ART. One hundred thirteen 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 avascular necrosis (AVN) in 39 (1.3%), and the most frequent autoimmune condition was psoriasis in 28 patients (1%). Compared with the 200 HIV patients without any diagnosis of rheumatic disease were the older patients with rheumatic conditions (mean age of 48.9 vs. 42.7 years; p < 0.01), and had a longer duration of HIV infection (mean duration of 15.5 vs. 10.3 years; p < 0.01). The odds of rheumatic conditions were 1.7 times higher in males (relative to females). 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). The proportion of 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 rheumatic condition.

Keywords

Antiretroviral therapy Avascular necrosis HIV Psoriasis Rheumatic diseases 

Notes

Acknowledgements

The authors thank Napatkamon Ayutyanont for support with statistical analysis.

Compliance with ethical standards

Disclosures

None.

Ethical standards

The institutional review board and the ethics committee of the Maricopa Integrated Health System approved the study before the collection of data (approval number 2015-126). Due to retrospective nature of the study no informed consent was obtained.

References

  1. 1.
    UNAIDS. Global AIDS update, 2016. [Internet. Accessed August 1, 2017.] Available from: www.unadis.org/sites/default/files/media_asset/global-AIDS-update-2016_en.pdf
  2. 2.
    Puhan MA, Van Natta ML, Palella FJ, Addessi A, Meinert C, Lewis RA et al (2010) Excess mortality in patients with AIDS in the era of highly active antiretroviral therapy: temporal changes and risk factors. Clin Infect Dis 51:947–956CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Aberg JA (2012) Aging, inflammation, and HIV infection. Top Antivir Med 20:101–105PubMedGoogle Scholar
  4. 4.
    Brothers TD, Rockwood K (2014) Biologic aging, frailty, and age-related disease in chronic HIV infection. Curr Opin HIV AIDS 9:412–414CrossRefPubMedGoogle Scholar
  5. 5.
    Freiberg MS, Chang CC, Kuller LH et al (2013) HIV infection and the risk of acute myocardial infarction. JAMA Intern Med 173:614–622CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Winchester R, Bernstein DH, Fischer HD, Enlow R, Solomon G (1987) The co-occurrence of Reiter’s syndrome and acquired immunodeficiency. Ann Intern Med 106:19–26CrossRefPubMedGoogle Scholar
  7. 7.
    Reveille JD, Conant MA, Duvic M (1990) Human immunodeficiency virus-associated psoriasis, psoriatic arthritis, and Reiter’s syndrome: a disease continuum? Arthritis Rheum 33:1574–1578CrossRefPubMedGoogle Scholar
  8. 8.
    Kaye BR (1989) Rheumatologic manifestations of infection with human immunodeficiency virus (HIV). Ann Intern Med 111:158–167CrossRefPubMedGoogle Scholar
  9. 9.
    Calabrese LH, Kirchner E, Shrestha R (2005) Rheumatic complications of human immunodeficiency virus infection in the era of highly effective antiretroviral therapy emergence of a new syndrome of immune reconstitution and changing patterns of disease. Semin Arthritis Rheum 35:166–174CrossRefPubMedGoogle Scholar
  10. 10.
    Maganti RM, Reveille JD, Williams FM (2008) Therapy insight: the changing spectrum of rheumatic disease in HIV infection. Nat Clin Pract Rheumatol 4:428–438CrossRefPubMedGoogle Scholar
  11. 11.
    Medina-Rodriguez F, Guzman C, Jara LJ et al (1993) Rheumatic manifestations in human immunodeficiency virus positive and negative individuals: a study of 2 populations with similar risk factors. J Rheumatol 20:1880–1888PubMedGoogle Scholar
  12. 12.
    Helmick CG, Felson DT, Lawrence RC, Gabriel S, Hirsch R, Kwoh CK, Liang MH, Kremers HM, Mayes MD, Merkel PA, Pillemer SR, Reveille JD, Stone JH, National Arthritis Data Workgroup (2008) Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part I. Arthritis Rheum 58:15–25CrossRefPubMedGoogle Scholar
  13. 13.
    Lawrence RC, Felson DT, Helmick CG, Arnold LM, Choi H, Deyo RA, Gabriel S, Hirsch R, Hochberg MC, Hunder GG, Jordan JM, Katz JN, Kremers HM, Wolfe F, National Arthritis Data Workgroup (2008) Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II. Arthritis Rheum 58:26–35CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Yang JJ, Tsai MS, Sun HY, Hsieh SM, Chen MY, Sheng WH, Chang SC (2015) Autoimmune diseases-related arthritis in HIV-infected patients in the era of highly active antiretroviral therapy. J Microbiol Immunol Infect 48:130–136CrossRefPubMedGoogle Scholar
  15. 15.
    Yen YF, Chuang PH, Jen IA et al (2016) Incidence of autoimmune diseases in a nationwide HIV/AIDS patient cohort in Taiwan, 2000–2012. Ann Rheum Dis 76:661–665CrossRefPubMedGoogle Scholar
  16. 16.
    Virot E, Duclos A, Adelaide L, Miailhes P, Hot A, Ferry T, Seve P (2017) Autoimmune diseases and HIV infection: a cross-sectional study. Medicine (Baltimore) 96:e5769CrossRefGoogle Scholar
  17. 17.
    Miller KD, Masur H, Jones EC et al (2002) High prevalence of osteonecorisis of the femoral head in HIV-infected adults. Ann Intern Med 137:1–25CrossRefGoogle Scholar
  18. 18.
    Martin K, Lawson-Ayayi S, Miremont-Salamé G, Blaizeau MJ, Balestre E, Lacoste D, Ragnaud JM, Malvy D, Dupon M, Mercié P, Schaeverbeke T, Haramburu F, Dabis F, for the Groupe d'Epidémiologie Clinique du SIDA en Aquitaine (GECSA) (2004) Symptomatic bone disorders in HIV-infected patients: incidence in the Aquitaine cohort (1999–2002). HIV Med 5:421–426CrossRefPubMedGoogle Scholar
  19. 19.
    Meyer D, Behrens G, Schmidt RE, Stoll M (1999) Osteonecrosis of the femoral head in patients receiving HIV protease inhibitors. AIDS 13:1147–1148CrossRefPubMedGoogle Scholar
  20. 20.
    Bongiovanni M, Chiesa E, Riva A, d’Arminio Monforte A, Bini T (2003) Avascular necrosis of the femoral head in a HIV-1 infected patient receiving lopinavir/ritonavir. Int J Antimicrob Agents 22:630–631CrossRefPubMedGoogle Scholar
  21. 21.
    Scribner AN, Troia-Cancio PV, Cox BA, Marcantonio D, Hamid F, Keiser P, Levi M, Allen B, Murphy K, Jones RE, Skiest DJ (2000) Osteonecrosis in HIV: a case-control study. J Acquir Immune Defic Syndr 25:19–25CrossRefPubMedGoogle Scholar
  22. 22.
    Mary-Krause M, Billaud E, Poizot-Martin I, Simon A, Dhiver C, Dupont C, Salmon D, Roudiere L, Costagliola D, Clinical Epidemiology Group of the French Hospital Database (2006) Risk factors for osteonecrosis in HIV-infected patients: impact of treatment with combination antiretroviral therapy. AIDS 20:1627–1635CrossRefPubMedGoogle Scholar
  23. 23.
    Fox C, Walker-Bone K (2015) Evolving spectrum of HIV-associated rheumatic syndromes. Best Pract Res Clin Rheumatol 29:244–458CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Ouédraogo DD, Ntsiba H, Tiendrébéogo Zabsonré J et al (2014) Clinical spectrum of rheumatologic diseases in a department of rheumatology in Ouagadougou (Burkina Faso). Clin Rheumatol 33:385–389CrossRefPubMedGoogle Scholar
  25. 25.
    Lau CS, Li P (2017) Epidemiology: the effects of AIDS on the prevalence of rheumatic diseases. Nat Rev Rheumatol 13:8–10CrossRefPubMedGoogle Scholar
  26. 26.
    Tsui JI, Cheng DM, Libman H, Bridden C, Samet J (2012) Hepatitis C virus infection is associated with painful symptoms in HIV-infected adults. AIDS Care 24:820–827CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Ogdie A, Pang WG, Forde KA, Samir BD, Mulugeta L, Chang KM, Kaplan DE, Amorosa VK, Kostman JR, Reddy RK, Schumacher RH, Lo Re V (2015) Prevalence and risk factors for patient-reported joint pain among patients with HIV/hepatitis C coinfection, hepatitis C monoinfection, and HIV monoinfection. BMC Musculoskelet Disord 16:93CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Vassilopoulos D, Chalasani P, Jurado RL, Workowski K, Aqudelo CA (1997) Musculoskeletal infections in patients with human immunodeficiency virus infection. Medicine (Baltimore) 76:284–294CrossRefGoogle Scholar

Copyright information

© International League of Associations for Rheumatology (ILAR) 2018

Authors and Affiliations

  • Konstantinos Parperis
    • 1
  • Yasir Abdulqader
    • 1
  • Robert Myers
    • 1
  • Bikash Bhattarai
    • 1
  • Muhsen Al-Ani
    • 2
  1. 1.Maricopa Integrated Health System and University of Arizona College of MedicinePhoenixUSA
  2. 2.University of WashingtonSeattleUSA

Personalised recommendations