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Musculoskeletal symptoms continue to affect over 50% of individuals with HIV, the virus that causes
AIDS. A variety of rheumatic disorders can be associated with HIV infection including joint pain,
arthritis, muscle pain, weakness, and fatigue, all of which can sometimes precede the diagnosis of
Fast facts
• HIV-associated rheumatic disorders can affect any age group, although they are more
commonly seen in young individuals between the ages of 20 to 40 years.
• Most HIV-associated rheumatic disorders improve with specific treatment of HIV.
• Some of the medications used to treat HIV/AIDS can cause joint pain or muscle weakness,
and can even cause some autoimmune disorders. If musculoskeletal and/or autoimmune
disorders do occur, medications should be reviewed for possible side effects causing the
musculoskeletal symptoms.
What are HIV-associated rheumatic diseases?
These are disorders of the joints and muscles that can result from the HIV infection. Painful joints and
muscles are usually the first and most common complaints. Less common, but as important, are a
variety of rheumatic conditions that can occur including infectious complications such as infected joints
(septic arthritis), muscles (tropical myositis, and bones (osteomyelitis), psoriatic arthritis, reactive
arthritis, polymyositis (inflammation of muscles), fibromyalgia, lymphomas, and inflammation of blood
vessels (vasculitis).

Patients with HIV infection may also experience musculoskeletal complications such as muscle disease
(myopathy), osteonecrosis, osteoporosis, and lipodystrophy resulting from medicines used to control
HIV infection.
What causes HIV-associated rheumatic diseases?
The musculoskeletal complications of HIV-associated rheumatic disorders have a number of different
causes. Infections including direct involvement of HIV and other viruses and/or bacteria can play
important role(s) in causing these complications.
Who gets HIV-associated rheumatic diseases?
HIV-associated rheumatic disorders affect individuals of all ages, ethnicities and genders. Common
risk factors for HIV include unprotected sex, IV drug abuse and, less commonly, blood transfusion.
How are HIV-associated rheumatic diseases diagnosed?
HIV-associated rheumatic diseases are suspected when an individual who is at high risk for HIV
infection develops painful joints and muscles or any other rheumatic condition. The diagnosis is
confirmed by the appropriate test for HIV.
How are HIV-associated rheumatic diseases treated?
The specific highly active antiretroviral therapy HAART (often referred to as the “cocktail” of HIV
drugs) introduced in the mid 1990s has markedly improved HIV-related symptoms, especially
inflammatory musculoskeletal conditions. Thanks to HAART, both the frequency and clinical severity of
the rheumatic disorder and long-term prognosis have greatly improved.
Additionally, most HIV patients with musculoskeletal complaints respond well to conventional
treatment with a combination of pain relievers and anti-inflammatory medications. Those who do not
respond to conventional treatment may require medicine to suppress the immune system and physical
therapy to relieve symptoms, prevent joint deformities and, most importantly, preserve
musculoskeletal function.
How can HIV-associated rheumatic diseases be prevented?
Some of the risk factors associated with HIV infection are shared with the risks of associated
rheumatic diseases. To prevent these risk factors, all individuals should use safe sex practices, and
those afflicted with HIV should make sure they take their specific antiretroviral therapy as prescribed
by their doctor.
Living with HIV-associated rheumatic diseases
HIV-associated musculoskeletal pain causes discomfort, muscle weakness, and impairment in
everyday function. A well-balanced diet and an exercise program are the best way to help HIV
patients maintain health.
Points to remember
• Any musculoskeletal complaint such as joint pain and muscle weakness that affects non-HIV
infected patients can occur in HIV-infected patients. Therefore, not all musculoskeletal
complaints in HIV patients are related to the HIV infection.
• HIV-associated rheumatic diseases may precede the diagnosis of HIV infection.

• The introduction of HAART has had a major beneficial effect on HIV infection and its associated
clinical manifestations.
To find a rheumatologist
For more information about rheumatologists, click here.
For a listing of rheumatologists in your area, click here.
For more information
The American College of Rheumatology has compiled this list to give you a starting point for your own
additional research. The ACR does not endorse or maintain these Web sites, and is not responsible for
any information or claims provided on them. It is always best to talk with your rheumatologist for
more information and before making any decisions about your care.
The Arthritis Foundation
The National Association of People with AIDS
Updated May 2008
Written by Luis R. Espinoza, M.D. and reviewed by the American College of Rheumatology Patient
Education Task Force.
This patient fact sheet is provided for general education only. Individuals should consult a qualified
health care provider for professional medical advice, diagnoses and treatment of a medical or health

© 2008 American College of Rheumatology