HIV/AIDS (musculoskeletal manifestations)

Last revised by Rohit Sharma on 17 Jan 2022

Musculoskeletal manifestations of HIV/AIDS are not as common as CNS or pulmonary complications. Nonetheless, their prevalence is high. 


Depending on the condition, etiology may be related to the HIV infection itself, the resultant immunodeficiency, or antiretroviral therapy (ART).


Infection is common in HIV patients, particularly those with low CD4 counts, and concomitant intravenous drug use

Manifestations include:

  • HIV: associated arthritis/arthralgia 1,4,5 
    • may result from the direct infection of the joint by the HIV virus  
    • usually, this is a self-limiting  mono- or oligoarthropathy, lasting 1-6 weeks
    • tends to affect large joints of the lower limb
    • radiographs are typically normal or demonstrate a joint effusion 
    • less commonly, there is chronic, erosive arthritis with joint space narrowing
  • reactive arthritis: may present with an incomplete clinical form of the disease, but radiographic features are the same as in non-HIV infected individuals
  • psoriatic arthritis: higher prevalence than in the non-HIV affected population
  • undifferentiated spondyloarthritis with clinical features of both reactive and psoriatic arthritides
    • possibly the most common form 4
    • radiographic findings include osteoporosis, soft-tissue swelling, bone erosions and periosteal reaction
  • rheumatoid arthritis and SLE may improve or remit in the setting of HIV infection

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