The clinical profile of patients diagnosed as having HIV infection with special reference to Joint manifestations and its correlation with CD4 count

Abstract

Introduction: India has the world’s third largest population suffering from Human Immuno deficiency virus(HIV) infectionV.HIV has many rheumatic manifestations and there is scarcity of studies exploring the spectrum of rheumatic manifestations in our population.Objectives: To study the prevalence and clinical profile of patients with HIV and to study the spectrum of Rheumatic manifestation in HIV and to determine any correlation with CD4 count.Study design: Descriptive study.Place and duration of study: Patients attending antiretroviral (ART) clinic of Government Medical College hospital, Thiruvananthapuram.Methodology: A structured questionnaire was given to 79 confirmed cases of HIV infection.The data was analyzed and the prevalence of rheumatic manifestations was determined.CD4 count was tested for any correlation with rheumatic manifestation or any of the other variables.Results and Discussion:The major mode of transmission was heterosexual ie in 94.9%.There was one case of reactive arthritis, one of fibromyalgia and 5 cases of HIV associated arthralgia.Rheumatic manifestations were seen in 8.9% of the study group.89.9%of the patients were on antiretroviral therapy and 45.6% reported improvement with treatment.CRP was positive in 10%,RA factor in 10% and ANA in 5.1%.46.8% patients had CD4 count less than 200,39.2% between 200-500 and 13.9% more than 500.The comparison between CD4 in different stages showed a significant difference(p-0.00).The mean CD4 of patients without rheumatic manifestations was 274.4cells/cubic millimeter and 263.7 cells/cubic millimeter in the presence of rheumatic manifestation. Opportunistic infections was seen in 43%.The mean CD4 count in patients without opportunistic infections was 364.Conclusion: Spondyloarthropathy one of the common rheumatic manifestations is not seen in the studied group. There was no statistical difference between CD4 count in HIV patients with and without rheumatic manifestation. The majority of the patients (90%) were on antiretroviral therapy which indicates the acceptability of treatment. Opportunistic infection was not seen in 57% patients suggesting the effectiveness and good adherence to ART.