Rheumatologic manifestations of infection with human immunodeficiency virus

Article Abstract:

The human immunodeficiency virus (HIV), which causes AIDS (acquired immunodeficiency syndrome), can produce symptoms in many parts of the body, including the brain, mouth, eyes, skin, gastrointestinal tract, lungs, muscles, bones, and connective tissues. The rheumatologic (concerned with the connective tissues) effects include arthritis (inflammation of joints), arthralgia (pain in joints), myositis (inflammation of muscles), vasculitis (inflammation of the blood vessels), the sicca syndrome (dryness of the eyes and mouth) and various autoimmune phenomena, including systemic lupus erythematosus. HIV infection is associated with several types of arthritis, most commonly Reiter syndrome or reactive arthritis, which is characterized by severe, persistent arthritis in the large joints of the lower extremities, and is associated with conjunctivitis and urethritis. Psoriatic arthritis with lesions of the skin and nails, arthritis due to infection with bacteria, and acute arthralgia may also occur with HIV infection. A type of arthritis that may be specific to AIDS has been described. Autoantibodies directed against normal body components are produced by individuals infected with HIV, including antibodies against various types of blood cells, such as platelets, lymphocytes, granulocytes, and red blood cells, as well as against components of the cells, including the nucleus and cardiolipin, a molecule found in the cellular organelle mitochondria. Infection with HIV may cause clinical symptoms similar to the autoimmune disease systemic lupus erythematosus. The Reiter syndrome, reactive arthritis, polymyositis, and the sicca syndrome may be one of the first clinical signs of HIV infection and may occur before the clinical signs of immunodeficiency. These rheumatic diseases may also occur in patients with full-blown AIDS. Physicians need to be aware of the possibility of HIV infection when patients develop rheumatological disorders. The drugs that are used to treat these disorders further suppress the immune system, which can have very serious adverse effects on an individual who is infected with HIV, leading to a faster progression to AIDS. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Physiological aspects, Rheumatic diseases, Systemic lupus erythematosus, Arthritis, Vasculitis, Myositis, Reiter's syndrome

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Esophageal ulceration induced by Zidovudine

Article Abstract:

The medication zidovudine (AZT) is currently the only drug that has been proven effective against the human immunodeficiency virus (HIV); it works by inhibiting viral replication. Patients with AIDS (acquired immunodeficiency syndrome) who take zidovudine should take it every four hours, even during the night, for maximal effectiveness. Ulceration of the esophagus, the passageway extending from the mouth to the stomach, was reported in three AIDS patients who were taking zidovudine. They all reported taking the pills without anything to drink while lying down in bed. Their ulcers healed after they stopped taking the drug. Symptoms of this type of injury usually include pain while swallowing, continuous "heartburn", or a feeling of having something stuck in the throat. Patients on zidovudine should take the capsules with at least four ounces of water and should sit up to swallow them. Persons infected with HIV are at particular risk from such ulcers; due to their compromised immune function, healing may proceed more slowly and the wound may become infected with Candida or cytomegalovirus. (Consumer Summary produced by Reliance Medical Information, Inc.)

Injuries, Prevention, Drug therapy, Ulcers, Dosage and administration, Zidovudine, Esophagus

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Trends in infectious diseases and cancers among persons dying of HIV infection in the United States from 1987 to 1992

Article Abstract:

Preventive treatment and better diagnosis and treatment of pneumocystosis in HIV-infected people may be responsible for the decrease in deaths among HIV-infected people. Data on secondary disease trends among people who died from HIV infection from 1987 to 1992 showed that the largest decrease in deaths was associated with pneumocystosis. Decreases in HIV-related deaths complicated by cryptococcosis and candidiasis were also noted. Pneumonia caused by unspecified organisms became the biggest secondary cause of HIV-related deaths due to the decrease in pneumocystosis. About 18% of HIV-related deaths were caused by pneumonia. Earlier detection of HIV and adequate medical care may enable HIV-infected people to receive better treatment for secondary diseases.

Patient outcomes, Mortality, Opportunistic infections

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