RHEUMATOLOGIC MANIFESTATIONS OF PEDIATRIC HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION

Objective. Multiple rheumatologic signs and symptoms have been describ ed in adult human immunodeficiency virus (HIV) infection. Our goals we re to determine the incidence and characteristics of rheumatologic man ifestations in HIV infected children, and to examine their relationshi p to laboratory evidence of autoimmunity. Methods. Forty HIV infected children were studied by means of a questionnaire, history, examinatio n, and serologic testing including determination of concentrations of immunoglobulin, C3, C4, and of presence of antinuclear antibodies (ANA ), rheumatoid factor (RF), and circulating immune complexes (CIC). Res ults. Rheumatologic manifestations included arthralgia (15%), myalgia (8%), erythema multiforme (3%), and parotitis (20%). Hypergammaglobuli nemia (98%), hypocomplementemia (25%), RF (10%), ANA (3%), and CIC (82 % of patients studied) were also found. Patients with or without rheum atologic manifestations did not differ significantly in any laboratory variable measured. Conclusions. In contrast to HIV infected adults, H IV infected children, do not display serious rheumatologic manifestati ons. Mild rheumatologic symptoms are common, but there is little evide nce that these are immune mediated. Parotid enlargement occurs and mus t be differentiated from Sjogren's syndrome. Differences between rheum atologic manifestations of HIV infection in children and adults may re flect host factors such as the immaturity of the pediatric immune syst em, or environmental factors such as modes of acquisition of HIV, dura tion of HIV infection, or exposure to other sexually transmitted organ isms.