Musculoskeletal Infections in Patients with Human Immunodeficiency Virus

Abstract

The objectives of this study were to study the clinical spectrum and the relationship between the CD4 count and musculoskeletal infection in patients with human immunodeficiency virus. A retrospective study of 156 HIV infected patients who attended the orthopaedic clinic at Bamrasnaradura Infectious Disease Institute from July 2002 through June 2005 was conducted by reviewing medical records in detail. The study group comprised of 118 men (75.6%) and 38 women (24.4%) with a mean age of 34.4 years (range 16-67). Musculoskeletal infection was presented in 18 cases (11.5%). Intravenous drug use was the only risk factor significantly associated with the development of musculoskeletal infection (p = 0.003). Eight patients who had septic arthritis had a mean CD4 count of 268.4 cells/mm3, six patients who had osteomyeli tis had a mean CD4 count of 138.8 cells/mm3 (p = 0.007) and four patients who had pyomyositis had a mean CD4 count of 25.8 cells/mm3 (p = 0.001). Septic arthritis occured in HIV-infected patients with mild decrease CD4 count ( > 200 cells/mm3). Patients with more decreased CD4 count (100 to 200 cells/mm3) had higher chance to have osteomyelitis and patients with the lowest CD4 count were more likely to have pyomyositis. Although the CD4 count could be used as a predictor of clinical course of musculoskeletal infection, identification of the organism remains important in the proper diagnosis and management of these infections.