Human immunodeficiency virus infection and inflammatory arthritis: A review of clinical and imaging features

Abstract

The reported prevalence of articular manifestations of human immunodeficiency virus (HIV) varies, but with sub-Saharan Africa accounting for almost 70% of the people living with HIV, this results in a considerable burden of disease in the region. The spectrum of clinical presentation described, includes articular pain syndrome, HIV-associated arthropathy and seronegative spondyloarthropathies, among others. This brief review serves to create awareness of the clinical and imaging presentation of this spectrum of disease as there is significant morbidity associated with these conditions if treatment is delayed.

FIGURE 1

Frontal radiographs of both hands in an HIV-positive patient presenting with polyarthritis. RF was negative. Radiographs demonstrate bilateral severe peri-articular osteopaenia, severe joint space narrowing involving almost all joints and subluxation at the 3rd, 4th and 5th proximal interphalangeal joints.

FIGURE 2

Magnified view of the 2nd and 3rd distal interphalangeal joints of the same patient discussed in Figure 1 demonstrates early erosions and irregularity of the distal phalanges (arrows).

FIGURE 3

Magnified view of the phalanges of the left 2nd, 3rd and 4th phalanges of the left hand of the patient discussed in Figure 1, demonstrating new bone formation of the proximal phalanx of the 4th finger and more clearly demonstrates the subluxations at the 3rd and 4th proximal interphalangeal joints.

FIGURE 4

(a) Frontal and (b) lateral radiographs of both hands of an HIV-positive patient presenting clinically with reducible deformities and arthralgia. Rheumatoid factor and anti-nuclear factor were negative. Lateral radiographs show subluxations at the metacarpophalangeal joints bilaterally as well as the distal interphalangeal joints of both 5th fingers. The right hand is more affected than the left, with the left hand demonstrating more reducible deformities on the frontal radiograph compared to the right hand.

FIGURE 5

Lateral radiographs (a and b) of both feet in an HIV-positive patient. The radiograph demonstrates periostitis and enthesitis affecting the right foot more than the left foot.

FIGURE 6

Magnified view of the proximal metatarsals and tarsal bones of the right foot clearly demonstrating periostitis (short arrows) and enthesitis (long arrows).