Musculoskeletal manifestations in pediatric patients infected with human immunodeficiency virus: Developing country perspective

Abstract

Objective: Musculoskeletal manifestations in children infected with human immunodeficiency virus(HIV) are responsible for increased morbidity and decreased quality of life. Even in this era of highlyactive anti-retroviral therapy (HAART), there are limited studies on different rheumatological manifes-tations in pediatric patients with HIV, and the spectrum of musculoskeletal manifestation in pediatricHIV is yet to be established.Methods: A single-center, prospective, observational study was carried out from October 2014 to Sep-tember 2016 in a tertiary care hospital of Eastern India with 517 children infected with HIV aged be-tween 3 and 19 years. Particulars of musculoskeletal involvement were at first screened with pediatricgait, arm, leg, spine (pGALS) screening protocol, followed by detailed examination in patients identi-fied through screening. All the participants were re-examined at three and six months of follow-up.Results: Musculoskeletal manifestations were found in 11.2% of the study population. The most com-mon non-infective manifestation found in the study population was arthralgia (5.22%), followed bymyalgia (3.29%). The prevalence of definite arthritis was found to be 6/1000 children, whereas in-fective manifestations (including arthritis, myositis, and osteomyelitis) were found in 2.12% of studypopulation. Musculoskeletal manifestations were commonly found in children infected with HIV whowere on anti-retroviral drugs. These manifestations were found commonly in the children in the sec-ond decade of their lives. Malnutrition, advanced stage of HIV infection (WHO clinical stage 4), lowerCD4 count at the time of evaluation, and longer duration of disease were associated with increasedfrequency of musculoskeletal manifestations.Conclusion: Musculoskeletal manifestations are frequent in pediatric population infected with HIV. Butfor better delineation, further multicentric studies are warranted in future in children infected withHIV.