HIV & Rheumatic Disease


People with HIV infection and acquired immunodeficiency syndrome (AIDS) often have problems in their joints, muscles, and bones. People may notice these problems before they know they have HIV. People of all ages, sexes, and racial or ethnic groups can get HIV and related rheumatic disease. People who have unprotected sex or use intravenous drugs with shared needles are at higher risk for contracting the virus. About 5 percent of HIV-positive patients have pain and inflammation in joints or soft tissues from HIV infection. They may have rheumatic diseases like septic arthritis, reactive arthritis, myositis, osteomyelitis, psoriatic arthritis, polymyositis, fibromyalgia, vasculitis, and others.

What Are the Signs/Symptoms?

Early signs include joint pain and swelling, arthritis, muscle pain, weakness, fatigue, and extra-articular problems, such as eye inflammation or uveitis. Diagnosis is based on an HIV blood test. Causes of the rheumatic illness could be the HIV infection itself, or an infection with another virus or bacteria the person contracts. HIV medications may also cause joint, soft tissue, muscle, or bone problems, as well as gout and immune reconstitution inflammatory syndrome. As their CD4 T cells recover, HIV patients may experience overwhelming systemic inflammatory symptoms.

What Are Common Treatments?

Antiretroviral drugs are used to treat HIV infection. Combination antiretroviral therapy of at least three drugs, or cART, is a drug “cocktail” used since the mid-1990s. This therapy significantly reduces HIV symptoms, including joint and muscle problems. Thanks to cART, fewer people with HIV get rheumatic disease or have less serious disease. Most people with HIV who have joint and muscle problems respond well to standard treatment. These include pain relievers and anti-inflammatory drugs to control pain, swelling and fever. People who do not respond to standard treatment for joint and muscle problems may need immunosuppressant medications. Physical therapy also may help them relieve symptoms, prevent joint deformities, and preserve function.

Living with HIV & Rheumatic Disease

Some things that raise the risk of getting HIV also raise the risk for HIV-related rheumatic disease. To lower your risk for both, use safer sex practices. If you have HIV, take your medicines as your health care provider has prescribed. Also, the Centers for Disease Control and Prevention suggest HIV routine screening in all healthcare settings for those aged 13 to 64 years. Certain groups should be especially targeted such as adults who are having sex, pregnant women (mainly under age 24) and men who have sex with men.

Updated February 2023 by Cheryl Crow, MOT, OTR/L, and reviewed by the American College of Rheumatology.

This information is provided for general education only. Individuals should consult a qualified health care provider for professional medical advice, diagnosis and treatment of a medical or health condition.

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