Adhesive capsulitis of shoulder and treatment with protease inhibitors in patients with human immunodeficiency virus infection: Report of 8 cases

Objective. To describe our experience with human immunodeficiency virus (HI V) infected patients receiving protease inhibitor therapy who presented wit h adhesive capsulitis of the shoulder. Methods. Between July 1996 and December 1999, 8 HIV-infected patients (7 ma le) treated with protease inhibitors who presented with adhesive capsulitis of the shoulder were retrospectively identified. Diagnosis of adhesive cap sulitis relied on clinical features including shoulder pain and both active and passive restricted range of motion (ROM). All available clinical and r adiographic data were reviewed. Results. Onset of symptoms was insidious, and at presentation, patients com plained of shoulder pain, which was bilateral in 4 of the 8 cases. Physical examination showed global restriction of active and passive ROM of the gle nohumeral joint. The mean delay between initiation of HIV protease inhibito rs and onset of shoulder pain was 14 months (range 2 to 36). The protease i nhibitor therapy always included indinavir. No underlying condition associa ted with secondary adhesive capsulitis of the shoulder, including shoulder trauma, diabetes mellitus, thyroid disease, pulmonary or cardiac diseases c ould be identified. In all 8 patients, despite continuation of therapy with indinavir, both shoulder pain and restricted ROM completely resolved, afte r a mean disease course of 7.4 months. Conclusion. Adhesive capsulitis of shoulder seems to be a new adverse event of HIV protease inhibitor therapy. In all reported cases, patients were tr eated with indinavir. Further observations will be necessary to confirm adh esive capsulitis as a side effect.