CD4+ counts predictive of musculoskeletal manifestations of HIV infection

Lymphocyte counts may be predictive of musculoskeletal problems in HIV-infected individuals, including infectious arthritis, which appears to be the most common musculoskeletal manifestation of HIV infection, according to a report by Spanish researchers.

Dr. Alejandro Olive and colleagues from Hospital Universitari Germans Trias i Pujol in Barcelona studied 74 HIV-infected patients with osteoarticular manifestations. Twenty-three percent of the patients had septic arthritis, with Staphylococcus aureus identified as the most common microorganism, according to the team’s report in the April issue of the Journal of Rheumatology.

In addition, 12.2% of the patients had soft tissue infections, 8.1% had spondyloarthropathies, 12.2% had lymphomas, 8.1% had osteomyelitis and 32.4% had other miscellaneous conditions, which included arthralgia, gout, tendinitis and osteonecrosis.

Among patients with septic arthritis, the mean CD4+ count was 164.7 cells/mm3, for those with soft tissue infections it was 127.1 cells/mm3, and for patients with spondyloarthropathies it was 245.8 cells/mm3, Dr. Olive’s team found. Among patients with lymphoma, the mean CD4+ count was 132.8 cells/mm3 and for those with osteomyelitis it was 233.6 cells/mm3.

Osteoarticular infections, the investigators found, always appeared when CD4+ counts were below 200 cells/mm3, and pyomyositis and lymphoma appeared when CD4+ counts were below 150 cell/mm3. “This suggests,” they say, “that musculoskeletal infections occur when HIV infection is advanced and that CD4+ counts may be predictive for particular musculoskeletal manifestations.”