HIV & Rheumatic Disease:Symptoms, Diagnosis & Home Testing, Treatment

Overview

HIV (human immunodeficiency virus) was first recognized about three decades ago. It is the virus that causes AIDS (acquired immune deficiency syndrome). Complications of HIV also include arthritis and rheumatic diseases, leading to pain and inflammation in the joints and muscle weakness.

In the United States now, over 1.1 million people are living with HIV infection, and almost 1 in 5 is unaware of the underlying infection. Rheumatic disorders are very common among people with HIV infection. It is estimated that about 70% patients affected with HIV may develop rheumatic conditions either before or after the diagnosis of the virus.

HIV-related rheumatic diseases can occur in any age, but most often in people between ages of 20 and 40. Fortunately, most HIV-related rheumatic diseases can get better under HIV treatment.


Cause

The direct cause for HIV-associated rheumatic diseases may be the HIV infection. People may get in touch with the virus through sex behavior without proper protection and intravenous drug use with shared needles. Although nearly 7 in 10 of patients under HIV infection may experience rheumatic disorders, some other viruses and bacteria can also play important roles in the process. So, confirming the diagnosis of HIV-related rheumatic diseases is quite significant.


Symptoms

HIV infection can result in various types of rheumatic conditions and each of them may display similar or different signs and symptoms. Rheumatic disorders that may be caused by HIV include:

  • Psoriatic arthritis
  • Reactive arthritis
  • Rheumatoid arthritis
  • Septic arthritis (infected joints)
  • Polymyositis
  • Vasculitis
  • Fibromyalgia
  • Arthritis in muscles (myositis) and bones (osteomyelitis)

Common symptoms of these rheumatic diseases are pain in arthritis, joints and muscles as well as muscle weakness.


Diagnosis & Home Testing

HIV-related rheumatic diseases may precede the detection of HIV infection. For a patient who has not been diagnosed with HIV, doctors may make diagnosis based on the patient’s risk of HIV infection and rheumatic problems such as painful joints and muscles. Then doctors would do a HIV test to confirm the diagnosis.

Generally, there are three types of HIV diagnostic tests. They include:

  • Antibody screening tests

Antibody screening tests detect the presence of antibodies, proteins that a person’s body produces against HIV, not HIV itself.

  • Antigen/antibody tests

Antigen/antibody tests search for both HIV antibodies and antigens in the blood. Antigens are foreign substances that cause your immune system to activate. If you’re infected with HIV, an antigen called p24 is produced even before antibodies develop. These tests are recommended for laboratory testing and are now common in the United States.

  • Nucleic acid test (NAT)

NAT is used to look for the actual virus itself in the blood. It is different from other tests in that it checks for genetic materials rather than antigens or antibodies. This test is very expensive and is not routinely the first test for HIV screening. But if the person recently had a high-risk exposure with early symptoms of HIV infection, your doctor would recommend it.

Apart from lab tests, the U.S. Food and Drug Administration (FDA) has approved two home test options: the OraQuick In-Home HIV Test and Home Access HIV-1 Test System. Both are sold at drugstores, but people need to be at least 17 years old to purchase them.

  • OraQuick In-Home HIV Test

In this test, you’ll swab your upper and lower gums and test the sample in a vial. You can get a result in 20 minutes. If one line appears, the test is negative. Two lines mean that a person may be positive. However, about 1 in 12 people get a false negative from this test. So, a follow-up test from a lab is necessary to confirm the status.

  • Home Access HIV-1 Test System

You need to prick a finger and collect a sample of blood on a special piece of paper. Then send the sample to a lab. A PIN number will be provided so that results remain anonymous. If it’s positive, the lab will also do a follow-up test.


Treatment

The treatment of HIV-related rheumatic diseases focuses on two directions: treating the symptoms related to arthritis and treating the HIV infection.

Generally, people use immunosuppressive medications like methotrexate for rheumatic diseases. But for HIV-associated rheumatic diseases, these medications may be contraindicated because HIV also results in immunosuppression. In this sense, experts concern that that this combination could compound the effects of immunosuppression, but there is not a lot of information about the safety of this practice.

HAART (Highly Active Anti-Retroviral Therapy) has been proved effective in treating HIV-associated rheumatic disorders. This therapy is a combination of drugs, including entry or fusion inhibitors, integrase inhibitors, protease inhibitors and so on. In this approach, treatment of HIV alone may improve the symptoms of a rheumatoid condition.

People with HIV-associated rheumatic conditions may also benefit from treatment with pain medications and anti-inflammatory drugs to reduce the symptoms of their rheumatic condition.


Keyword: HIV-related rheumatic diseases.


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