The changing spectrum of rheumatic disease in HIV infection

Background: Rheumatic manifestations were described soon after human immunodeficiency virus (HIV) was discovered. Since however, combination anti-retroviral therapy (cART) has revolutionized the course of the infection. Less clear is what effect cART has had on rheumatic manifestations. Sources of data: References were retrieved from the PubMed database using keywords including: 'HIV' and 'arthritis'; 'myalgia'; 'arthralgia' and other disease-specific terms, e.g. 'rheumatoid arthritis'. Areas of agreement: Musculoskeletal pain was common in HIV and increased with AIDS. Immune restoration inflammatory syndrome on initiation of cART causes de novo autoimmune inflammatory rheumatic disorders. Seronegative inflammatory arthritis with/without axial involvement has been reported widely with HIV. Areas of controversy: It is unclear if HIV causes these conditions, creates an environmental milieu supportive of these conditions or acts as a marker of other risk factors. It is unclear what effect cART has had on these conditions. Growing points: Variable diagnostic classification criteria have caused this literature to be poorly comparable. Areas timely for developing research: High-quality controlled epidemiological studies using standardized criteria are needed among cART users. Treatment of active autoimmune disease in HIV patients needs to be evaluated formally.