Musculoskeletal manifestations in patients positive for human immunodeficiency virus: Correlation with CD4 count

Objective. To determine the relationship between the CD4+ lymphocyte count and musculoskeletal manifestations of human immunodeficiency virus (HIV) in fection. Methods. All patients from 1991 to 1998 who were positive for HIV with oste oarticular manifestations were reviewed retrospectively. HIV positivity was confirmed by ELISA and Western blot. CD4 count was performed by flow cytom etry. Results. We studied 74 patients with osteoarticular manifestations. The stu dy group comprised 61 men (82.4%) and 13 women (17.5%) with a mean age of 3 4.2 years (range 17-62). Fifty-two patients were iv drug users (70.3%). Sep tic arthritis was present in 20 cases (23.0%), soft tissue infections in 9 cases (12.2%), spondyloarthropathies in 6 cases (8.1%), lymphomas in 9 case s (12.2%). osteomyelitis in 6 (8.1%), and 24 miscellaneous cases (32.4%). T he mean CD4 count was as follows: septic arthritis 164.7 cells/mm(3), soft tissue involvement 127.1 cells/mm3, spondyloarthropathies 245.8 cells/mm(3) . lymphoma 132.8 cells/mm(3), and osteomyelitis 233.6 cells/mm(3). Conclusion. Osteoarticular manifestations in the setting of HIV infection t end to be predominantly infectious. S. aureus is the microorganism most fre quently involved. Ostearticular infections always appeared when the CD4 cou nt was < 200 and pyomyositis and lymphoma appeared when CD4 was < 150. CD4 counts may be useful predictors to determine the type of musculoskeletal ma nifestation.