ASSOCIATED WITH HIV-INFECTION IN ZIMBABWE

Objective, To document the clinical and immunogenetic features of arth ritis associated with heterosexually acquired human immunodeficiency v irus (HIV) infection. Methods. All patients were assessed by a rheumat ologist and standard laboratory tests were per formed. Results. There were 3 common clinical presentations. (1) Oligo/polyarticular arthriti s (22 men, 4 women). HIV infection had not previously been diagnosed i n 24 of these patients but persistent generalized lymphadenopathy (85% ) and weight loss (42%) were present. Joints commonly involved were an kles (65%) and knees (54%), often with associated enthesitis (31%) and dactylitis (23%). Followup data in 18 patients showed that arthritis resolved completely in 9 patients (one subsequently recurred), improve d by >50 in 5 patients, was unremitting in 3 patients, and recurred fr equently in one patient. None of 7 patients tested were HLA-B?7 or B7 positive. 12) Reiter's syndrome (RS) (21 men, 3 women; incomplete RS 1 8 patients, complete RS 6 patients). Lymphadenopathy was present in 19 patients (79%) and 4 patients were previously known to have HIV infec tion. Involvement of knees (80%) and ankles (58%) was common, as were enthesitis (29%) and dactylitis (13%). Followup data in 21 patients sh owed that 14 resolved (5 with recurrences), 2 improved by >50%, and 5 had continued arthritis, HLA-B27 was not found in 13 patients tested b ut a cross reacting antigen was found in 6 patients. (3) Symmetrical p olyarthritis (4 men, 4 women), Symmetrical arthritis of the wrists (8 patients) and peripheral interphalangeal (PIP) and metacarpophalangeal (MCP) joints (7), as well as lymphadenopathy (5), nodules (4), rheuma toid factor (3), and erosive radiographic changes (one patient) were s een. (4) Miscellaneous. Other types of arthritis included 3 patients w ith psoriasis and arthritis and one patient each with Behcet's disease , Salmonella septic arthritis, and secondary syphilis. Conclusion. Art hritis associated with HIV in this population is most commonly charact erized by oligoarticular. asymmetrical, large joint arthritis, with or without features of Reiter's syndrome, and is not associated with HLA -B27.