Joint pain due to HIV: prognosis, symptoms, etiology

Joint damage in HIV and AIDS is the main symptom of the influence of infection on the patient’s body. These are irreversible processes, the treatment of which is to reduce pain and swelling of the tissues, and prevent tendon deformation. Men are more at risk of developing infectious arthritis than women. At the same time, other symptoms of HIV appear. Therapy for the musculoskeletal system must be consistent with general treatment; for this it is important to fully follow the instructions of the treating doctor.

Why and where do they hurt?

Reasons why joint pain appears in HIV-infected patients:

disorganization of the work of lymphocytes;
provoked inflammation;
the appearance of infectious arthritis;
increasing the risk of tumor appearance and enlargement;
disruption of blood circulation in bone tissue and joints.

The immunodeficiency virus provokes a painful syndrome in the joints, muscles and aching bones. The immune system decreases and the body becomes more susceptible to the appearance of pathologies of the musculoskeletal system.

The pain appears due to the intensification of such ailments that are aggravated by HIV:

HIV increases the symptoms of other diseases, such as osteoporosis.

joint arthralgia;
arthritis caused by infection (psoriatic, septic and reactive);
polymyositis;
osteoporosis;
osteonecrosis;
tuberculosis;
rheumatological diseases.

Pain in the joints due to lesions of the musculoskeletal system manifests itself already in the initial stages of HIV and accompanies the disease at all stages of development. The pain is aching, long-lasting (for days), worsening the comfort of a person’s life. Often appears at night. The large joints of the musculoskeletal system (elbow, shoulder and knee) are most affected. In this case, several affected areas may be observed, the back and neck suffer. Symmetrical and asymmetrical lesions are observed.

Main stages of the disease

The stages of HIV are divided into the following:

incubation This is the stage at which infection and subsequent multiplication of the virus in the blood occurs. It lasts up to six weeks, sometimes less. Even if infected, at this stage a person will not see obvious signs, and a blood test will not show that there are antibodies in the blood;
primary. The first signs of infection may already appear here. The second stage lasts for 3 weeks - at this time antibodies appear, the virus is determined in the laboratory;
subclinical. The first sign of the disease appears - enlarged lymph nodes. The patient feels completely healthy and does not complain about his health;
the appearance of secondary diseases. The immune system begins to malfunction, causing a variety of diseases to appear: from frequent colds and candidiasis to pneumonia, tuberculosis;
terminal. The stage involves exhaustion (rather rapid and progressive), as well as the subsequent death of the patient.

The stages do not have one correct time frame - they may differ from person to person. For example, HIV-infected people often feel well for years or do not pay attention to small signs. The disease is detected only at the stage of severe deterioration in health or through random tests.

What to do about the problem?

It is impossible to restore damaged joint tissue with HIV. The main goal of therapy is to relieve pain, alleviate the patient’s condition and stop the destruction of joint structures. Self-treatment is unacceptable. Only the attending physician, who knows the complete clinical picture of the patient, has conducted extensive diagnostics and monitors the medications the patient is taking in parallel, can prescribe a therapy method and medications. With the help of painkillers, analgesics and anti-inflammatory drugs, it will be possible to temporarily eliminate pain, but not get rid of the pathology. Ignoring degenerative changes will accelerate the course of the disease, complicate the disease and lead to irreversible pathological processes in the joints.

Compresses, infusions, teas, ointments from traditional medicine do not give significant results. They help enhance the effects of traditional therapy, increase the overall functionality of the body, and improve the elasticity of joints. When used independently, products from herbal components do not have the necessary therapeutic effect. It is better to use topical medications that penetrate the injured joint faster. The name of the medication and the dosage regimen are determined by the doctor. It is important to maintain proper nutrition, drink the amount of clean water recommended by your doctor, avoid heavy physical activity and balance your work and rest schedule.

Source etosustav.ru

When a person finds out that he is infected with the immunodeficiency virus, premature death is not the worst thing to think about. Pain is a painful consequence of the development of the disease. What hurts with HIV, and is it possible to fight the pain?

Arthritis due to HIV

What kind of pain can HIV infection cause?

Already in the early stages of the infection, muscle soreness appears (characteristic is aching muscle pain). This is a consequence of damage to muscle tissue. It is observed in 1/3 of all infected people. Primary muscle damage is called myopathy. Movements become constrained and cause discomfort. The extreme degree of tissue damage is polymyositis. A person becomes disabled. He is practically immobilized, the slightest dynamics causes suffering.
With HIV infection, changes affect all components of the musculoskeletal system. Patients have pain in the spine, joints, and aching bones. More than half of the carriers complain of such sensations. The virus primarily affects large joints:

hip;
shoulder;
elbows;
knee

Gradually, stiffness spreads to small joints. Fingers begin to crack. Painful movements are clearly evident in the morning. Then the infected person develops his limbs, and during the day the pain disappears. Typically, this phenomenon disappears as the disease enters a latent stage. It is due to the fact that the delivery of nutrients and oxygen to the tissues of the motor system is disrupted.

Joint pain itself does not indicate HIV. But if a person experiences several arthritic processes at the same time, additional research will not hurt. A blood test will help determine whether you have a viral load.

A person with retroviral infection complains of neck pain. The cause is often bacterial infections, which manifest as oral ulcers. Local inflammatory processes that accompany the penetration of HIV into the body cause enlargement of the lymph nodes in the neck and jaws.

Various viral and bacterial infections attack a person with HIV. This happens due to a drop in the level of T-lymphocytes in the blood. Immunodeficiency viruses infect these cells first. The course of infections is accompanied

weakness;
body aches;
rise in temperature;
enlarged lymph nodes.

At the pre-AIDS stage, the disease is complemented by opportunistic infections. As the disease progresses, it becomes more and more difficult to fight them. AIDS is characterized by the irreversibility of concomitant diseases. At this stage, the patient’s life is filled with pain of varying intensity and origin. Early diagnosis and timely initiation of therapy help maintain health and avoid dire consequences.

First stage: acute HIV infection

Infection and subsequent development of the virus can occur asymptomatically. But at this stage, a fairly large concentration of the virus circulates in the blood of the infected person, and its transmission can occur in the main ways: through blood or biological fluids. Statistically, ARVI symptoms are recorded more often within 2-4 weeks after infection. Their appearance can be explained by the body’s natural reaction to the penetration of a foreign agent. Defensive reactions are aimed at one thing - killing the virus. But, unfortunately, this is impossible. Once the virus has entered the body, it will remain there. Of course, over time this process will normalize. The immune system contains and controls the virus, increases the production of protective immune cells, but their number will not become the same and will not return to its original level, because they are destroyed by the virus. There are a number of alarming symptoms that require attention, especially if there is a risk and likelihood of infection:

muscle and joint pain;
increased fatigue;
long-term low temperature;
frequent stomatitis in the oral cavity;
night sweats;
rash on the body;
mild to severe sore throat;
enlarged lymph nodes, etc.

Second stage: clinical latency

At this stage, the virus is active, but reproduction occurs at a very low level. At this stage, which is also called asymptomatic, emerging signs are ignored. After all, there will always be excuses for increased fatigue and decreased performance. If treatment began at this stage or even earlier, then the asymptomatic stage can be maintained throughout life. However, if treatment has not begun or is ignored for some reason, then this stage can last about 10 years and progress to the third stage. Antiretroviral therapy reduces the concentration of the virus in body fluids to the point that it is undetectable and the virus is not transmitted. This is a kind of prevention of the spread of HIV and AIDS, but this does not mean that you do not need to take any precautions and not use barrier methods of contraception.

Third stage: symptoms of HIV that has turned into AIDS

Human acquired immunodeficiency syndrome is the third stage of development, and is a completely different diagnosis. A syndrome is understood as a complex, a set of symptoms that characterize a specific disease. In people who receive high-quality treatment, the level of immune cells remains at the proper level, and the third stage of development does not occur, at least this probability is extremely low. And without treatment, the viral load increases, which leads to a significant decrease in the number of immune cells, and this is already dangerous not only for health, but also for life.

Symptoms of the third stage vary as they are associated with the development of various opportunistic infections, but the most likely include:

vision changes;
prolonged diarrhea;
significant enlargement of lymph nodes;
increased fatigue, decreased performance;
fever that comes and goes;
depressive disorders;
complications of respiratory diseases;
weight loss;
frequent exacerbations of dental diseases, usually of the mucous membrane;
sores and rashes in the genital and anal areas.

Diseases that typically develop during this stage include tuberculosis, fungal infections, serious respiratory infections, and even some types of cancer.

Features of symptoms in men and women

The virus can affect both men and women. However, static data show that among those who become ill, it is men who are more likely to be infected: in 2010, 76% of those who became ill were members of the stronger sex. There may be differences in the clinical picture between men and women, because even their immune system has its own characteristics. It is known that in men the infection often occurs without symptoms, and those that are present remain unattended for a long time, which cannot be said about women. First of all, we are talking about vaginal fungal infections, which are considered opportunistic. Of course, the appearance of vaginal candidiasis is not a specific sign of HIV, but if it appears frequently and is difficult to treat, this is a reason to visit a doctor and undergo an appropriate examination. Typical symptoms of vaginal candidiasis include:

itching, burning in the vulva and perineum;
pain during sexual intercourse;
burning and pain when urinating;
thick, white, cheesy discharge with a characteristic sour odor.

Women's mood can be unstable and directly depend on hormonal levels.
As the infection progresses, it can cause severe mood changes and even cause some neurological disorders. Depression, a constant feeling of hopelessness, chronic stress, etc. may develop. HIV-infected women note that menstruation is heavier, more painful, and there is often a disruption in the regularity of the cycle. Text: Yulia Lapushkina

Sore throat

With HIV, the patient often has a sore throat. Soon after infection, a sore throat may be caused by:

If the cause of a sore throat is a viral infection, it cannot be cured using traditional methods. It is necessary to take strong drugs. This feature is characteristic of the presence of HIV in the body. When a patient cannot be cured of a common cold for a long time, his blood is sent for additional tests.

The negative impact of the human immunodeficiency virus on the ENT organs increases over time. At the stage of AIDS, sore throats that occur in severe forms cause a lot of trouble to the patient.

Causes of pain in people with HIV

There are various causes of pain associated with HIV, and the location and severity of the pain may vary. It is necessary to see a doctor to determine the possible cause of the pain and develop an appropriate treatment plan.

Some people living with HIV may experience short-term pain from secondary infections, injuries, or surgeries. Short-term pain usually goes away once the body recovers. Many people living with HIV experience chronic or long-term pain. In one study of 238 people living with HIV, 53% of participants reported chronic pain in the past 6 months.

Chronic pain in people living with HIV may result from:

direct impact of HIV on the body;
nerve damage, also known as peripheral neuropathy;
cancer;
opportunistic infections.

Headaches with HIV

Headaches with HIV at the initial stage accompany common infections.

Arthrozax for joints, arthritis and arthrosis: quickly relieves diseases of the musculoskeletal system!

Reasons that cause severe pain in a later period:

damage to the central nervous system;
oncological diseases;
brain damage due to infections.

To save yourself from suffering from AIDS or delay its approach, a person with a positive HIV status should be attentive to the state of their health. It is recommended to inform your doctor about any changes.

Source aids24.ru

Quite often it happens that joints hurt with HIV. The reason for this phenomenon is considered to be the development of degenerative-dystrophic changes in osteochondral tissue against the background of the aggressive spread of the virus and a decrease in the protective function of the body. Diseases of the musculoskeletal system in HIV infection are observed in more than 50% of patients.

How to treat?

HIV infection

There are many drugs that, when combined, provide good protection against the development of HIV infection. There is no single best treatment - therapy is selected individually. Over time, resistance to some drugs may develop, and then they are changed. Moreover, the emergence of resistance to one drug may also mean that the virus becomes immune to other similar drugs that have not been used before.

To ensure this happens as rarely as possible, medications must be taken without skipping, at the same time every day. Now it has become more convenient to do this: two or three drugs can be combined into one tablet. Typically you need to take 1 to 4 tablets per day. Most often, there are no recommendations regarding whether to take medications before or during meals. But if the drug must be taken on an empty stomach, remember what this means: one hour before meals or two hours after it.

To make it easier to take your medications on time, buy a pill bottle and fill it for a week, leaving it in a visible place. You can also tie your medication intake to some daily activity (for example, brushing your teeth or feeding your dog) or set a reminder on your phone. Place some of the medications in different places (desk drawer at work, backpack, bag) so that the medications are always available.

Modern medications cause fewer adverse reactions than older ones. However, this still happens. Usually, all side effects gradually go away, so if they occur, you should consult a doctor, but do not stop taking the medications. The most common adverse reactions that occur in patients with hepatitis are nausea, vomiting, pain in the right upper abdomen, fatigue, loss of appetite, yellow skin and sclera (the outer lining of the eye). You should definitely inform your doctor about this.

Remember that these drugs may interact with other medications you take (such as cholesterol-lowering medications, asthma medications, or heartburn medications). Preparations based on plants (in particular St. John's wort, garlic, thistle) reduce the concentration of the drug in the blood.

For a person with HIV infection but a well-functioning immune system, it is better to get several vaccinations: against influenza (done annually), hepatitis B, pneumococcus, diphtheria, tetanus, whooping cough, etc. It is better to talk more about this need with your doctor.

Despite the fact that the state is obliged to provide people with HIV with ART, unfortunately, problems often arise here. At the same time, the market price of such drugs is quite high.

AIDS

If a person is diagnosed with AIDS, then often, in addition to ART, he also needs to take antibiotics and antifungal drugs as prophylaxis.

How to avoid infecting anyone?

HIV is not transmitted in everyday life: through shared plates or towels. You can become infected through unprotected vaginal or anal sex, or by sharing a needle with an infected person.

If a person with HIV infection takes ART and the amount of virus in his blood is so small that it cannot be detected by conventional tests, then the risk of infecting a sexual partner approaches zero. In any case, using a condom protects against HIV transmission. There is another effective method of prevention, although it is quite expensive. This drug is Truvada, and must be taken by the uninfected partner before sexual intercourse.

HIV infection - with proper treatment, it is not at all as dangerous as it was in the 20th century. Many people live with HIV, get married, become parents of healthy children and do not experience any health problems. Therefore, if you find out that you have HIV, do not hesitate to make an appointment with a good infectious disease specialist.

Etiology and pathogenesis of joint pain

Under the influence of HIV infection, the body's protective functions are activated and produce antibodies to the pathogen. Their detail lies in the destruction and disposal of diseased connective tissue cells. Due to severe disturbances in the body, dysfunction of the immune system occurs. This leads to the fact that antibodies destroy not only pathogenic agents, but also healthy cells of their own body. Under the influence of a negative factor, all organs and systems suffer, including the musculoskeletal system.

People who are prone to the development of rheumatic syndromes are: HIV carriers, patients with a clear clinical picture of infection, and people with total damage to the immune system (AIDS).

Large joints are mainly affected by immunodeficiency. More often, the patient experiences pain at night, which is associated with impaired blood circulation in the osteochondral tissue. As a rule, the pain syndrome is short-lived and goes away after a few hours without the use of medications. With significant degenerative disorders, symptoms subside due to the development of rheumatic syndromes.

Managing pain in people with HIV

There are many ways to manage HIV-related pain. Doctors may prescribe medications to reduce painful symptoms. People living with HIV can also buy medications without a prescription, but they should talk to their doctor before starting any new medications. Non-drug therapy and home remedies can also help people.

Below we discuss various treatment options:

Medications

Some HIV medications can increase a person's sensitivity to pain. One of the first approaches doctors take to treat painful symptoms is to either stop or reduce the dose of HIV medications. If this approach doesn't work, your doctor may recommend prescription or over-the-counter medications.

Some of these options include:

Opioids

: This is the strongest type of pain medication available only by prescription. Opioids can cause side effects such as drowsiness, nausea, and constipation. It is important to follow your doctor's instructions for taking opioids to prevent complications and overdose.

Non-opioid drugs

: acetaminophen, aspirin and ibuprofen. Topical pain relievers such as gels, creams and patches are also available.

Non-drug therapy

Some people may also find pain relief by using:

acupuncture;
massage;
cognitive behavioral therapy;
joining a chronic pain support group.

Home Remedies

Some ways to combat HIV infection at home include:

practicing relaxation techniques such as meditation and breathing exercises;
use of hot and cold compresses;
if necessary, taking warm baths;
regular physical activity;
identifying and reducing the causes of stress;
limiting alcohol consumption;
to give up smoking.

Symptoms and course of HIV-associated arthritis

At the initial stages, pain in the joints is perceived as manifestations of neuropathy. Only after the appearance of more serious symptoms in the form of swelling and hyperemia of the periarticular skin does a suspicion arise about the development of arthritis. The disease is inflammatory in nature and provokes disruption of venous and arterial blood flow inside the joint.

HIV-associated arthritis

A severe form of the disease, which leads to complex internal disorders and obvious visual changes in the structure of the joint. It is a rapidly progressing disease and manifests itself acutely. It mainly affects the joints of the lower and upper extremities with deformation of the phalanges of the fingers. It draws the periarticular tendons into the pathological process. The main symptoms of this type of arthritis are severe pain with increasing intensity and swelling of the soft tissues. With the active development of the disease, there are disruptions in the hydration and nutrition of the skin, which is manifested by dryness and rejection of the upper layers of the epidermis. A severe form of the disease leads to complications in the form of inflammation of the mucous membranes of internal organs.

HIV-associated reactive arthritis

The first signs of the disease appear in the first weeks of infection entering the body. In this case, the person does not suspect that he is HIV-infected, but at the same time experiences all the extensive symptoms of arthritis:

Diseases of the musculoskeletal system

In reactive arthritis, the lymph nodes become enlarged.

pain syndrome, which is more pronounced after waking up;
swelling of the joints;
hyperemia of periarticular tissues;
inflammatory reaction in other structural units;
enlarged lymph nodes due to improper blood flow;
thickening of the toes.

Reiter's syndrome

The peculiarity of the disease is that in addition to the joints, the tendons, genitourinary system and organs of vision are affected. The rheumatic manifestation of the syndrome boils down to the following symptoms:

pain in the affected joints;
formation of contracture;
inflammation of the synovial membrane;
redness of the skin;
swelling of the fingers;
heel spurs.

HIV-associated psoriatic arthritis

Along with joint pain, skin manifestations of the disease appear. In advanced cases, severe forms of seborrhea and psoriasis develop. The disease is manifested by redness of the skin and rashes, which over time turn into erosions and become covered with a keratinized crust. Damaged areas of the epidermis become rough and compacted. Against the background of negative factors, arthritis begins acutely and progresses quickly.

The course of arthritis in HIV is divided into two groups: asymmetrical damage to large joints and symmetrical development.

Treatment

The prognosis depends on what stage of development the HIV infection is at. Antiretroviral therapy and treatment of opportunistic infections are carried out. In cases where the pain is periodic, painkillers are prescribed. For arthritis, non-steroidal anti-inflammatory drugs are used. The complex necessarily includes exercise therapy and physiotherapeutic procedures.

If the above measures do not help, then sulfasalazine is prescribed. Immunosuppressants and methotrexate, which are often used for arthritis, are used with great caution in the treatment of HIV-infected people, since they can provoke the progression of infection and the degeneration of neoplasms into malignant ones. If Reiter's syndrome or psoriatic arthritis progresses, the situation is corrected by joint replacement.

The presence of HIV infection is not an obstacle to endoprosthetics, although some hospitals refuse to accept such patients under various pretexts and fear complications. But in the Russian Federation there are clinics where HIV-infected people undergo joint replacement surgeries according to quotas. According to the law, a patient, even under a quota, can independently choose a medical institution from the list of participants in the compulsory medical insurance program, but the problem is that such patients are not accepted everywhere. You have to spend a lot of time and nerves searching, and when they give a positive answer, you have to wait in line, sometimes up to a year.

Many who have the financial means go for treatment to Germany or Israel, where they perform high-quality operations on HIV-infected patients with the same percentage of complications as in HIV-negative patients.

Other joint lesions

There are severe cases when psoriatic and reactive arthritis are combined with Reiter's syndrome. And also against the background of immunodeficiency, secondary joint damage develops. Such arthritis is of bacterial origin and is provoked by various fungi, tuberculosis and infectious hepatitis. In addition to joints, soft tissues are often affected. This leads to the development of bursitis, tendonitis, periarthritis, periarthrosis, and synovitis. Sometimes other rheumatic syndromes (polymyositis, vasculitis) also occur.

What is the prognosis for joint pain and HIV?

The development of degenerative destruction in bone and cartilage tissue depends on the severity of HIV infection. With timely treatment of the concomitant disease, the clinical manifestations of arthritis completely disappear, and structural changes in the joints stop. With the development of AIDS, complex dystrophic joint lesions are observed. This condition occurs against the background of a secondary fungal infection or purulent inflammation.

Source osteokeen.ru

Damage to the musculoskeletal system due to HIV infection

... in 30-70% of cases, pronounced clinical polymorphism of HIV infection includes rheumatological manifestations . Arthralgia is the most common rheumatic manifestation of HIV infection; in this case, the pain is usually mild, intermittent, has an oligoarticular type of lesion, and primarily affects the knee, shoulder, ankle, elbow and metacarpophalangeal joints. In some cases, but more often in the later stages of the disease, severe pain in the joints of the upper and lower extremities (usually in the knee, elbow and shoulder joints) may occur, lasting less than 24 hours. HIV-associated arthritis is similar to arthritis that develops with other viral infections and is usually characterized by subacute oligoarthritis affecting (predominantly) the joints of the lower extremities in the absence of soft tissue pathology and association with HLA B27. Inflammatory changes are not detected in the synovial fluid. When radiography of the joints, pathological symptoms are usually not detected. As a rule, spontaneous relief of articular syndrome is observed. HIV-associated reactive arthritis is characterized by typical symptoms of seronegative peripheral arthritis with predominant damage to the joints of the lower extremities, the development of severe enthesopathies, as well as plantar fasciitis, Achilles bursitis, dactylitis (“sausage fingers”) and severe limitation of patient mobility. Vivid extra-articular manifestations are noted (keratoderma, annular balanitis, stomatitis, conjunctivitis), detailed symptoms of the HIV-associated complex in the form of low-grade fever, weight loss, diarrhea, lymphadenopathy. Damage to the musculoskeletal system of the body is not typical. The course is usually chronic and relapsing. HIV-associated reactive arthritis can occur more than two years before the diagnosis of HIV infection or against the background of the onset of clinical manifestations of AIDS, but most often manifests itself during the period of already existing severe immunodeficiency. HIV-associated psoriatic arthritis is usually characterized by rapid progression of joint manifestations, and a correlation between the severity of skin and joint damage. Remember: any patient with a severe attack of psoriasis or a form of the disease that is resistant to conventional therapy should be tested for HIV infection. HIV-associated polymyositis develops quite early and may be one of the first manifestations of muscle damage. Its main manifestations are similar to those in idiopathic polymyositis: myalgia, weight loss, weakness of proximal muscle groups, increased serum CPK, the electromyogram is characterized by a myopathic type of changes in the form of: myopathic action potentials of motor units with early activation and complete low-amplitude interference; fibrillation potentials, positive sharp waves. Muscle biopsy reveals signs of inflammatory myopathy: inflammatory infiltration of the perivascular and interstitial area around myofibrils in combination with their necrosis and repair. Nemaline myopathy is characterized by muscle weakness, hypotonia of the muscles, which first appear in the pelvic girdle, then in the muscles of the shoulder girdle, and then become generalized as the disease progresses. When examining muscle fiber biopsies under a light microscope, nemaline bodies are revealed in the form of rod-shaped or thread-like inclusions located under the sarcolemma or in the thickness of the muscle fiber. Myopathy in “HIV-related cachexia” is diagnosed when the following criteria are met: weight loss of more than 10% of baseline, chronic diarrhea (>30 days), chronic fatigue and documented fever (>30 days) in the absence of other causes. Septic arthritis as part of HIV infection usually develops in intravenous drug users or with concomitant hemophilia. The main causative agents of septic arthritis are gram-positive cocci, Haemophilus influenzae, and salmonella. The disease manifests itself as acute monoarthritis, predominantly of the hip or knee joint. Possible damage to the sacroiliac, sternocostal or sternoclavicular joints. In general, HIV infection does not have a significant effect on the course of septic lesions of the musculoskeletal system, which (complications), as a rule, can be successfully cured with adequate antibacterial therapy and timely surgical intervention. Tuberculous spondylitis, osteomyelitis, arthritis. Tuberculosis is one of the most frequently life-threatening HIV-associated opportunistic infections. At the same time, lesions of the musculoskeletal system account for 2% of cases. (!) The most common localization of the tuberculosis process is the spine, but there may be signs of osteomyelitis, mono- or polyarthritis. Unlike classical Pott's disease, tuberculous spondylitis as part of HIV infection can occur with atypical clinical and radiological symptoms (mild pain, lack of involvement of intervertebral discs in the process, the formation of foci of reactive bone sclerosis), which leads to delays in diagnosis and timely treatment. Damage to the osteoarticular system by atypical mycobacteria usually develops in the later stages of HIV infection, when the level of CD4 lymphocytes does not exceed 100/mm3. Among the pathogens of this group, M. haemophilum and M. kansasii predominate. In this case, several foci of infection are noted, and manifestations such as nodules, ulcers and fistulas are observed in 50% of patients. Mycotic joint damage in HIV-infected patients. The main pathogens are Candida albicans, Sporotrichosis schenkii and Penicillium marneffei (in southern China and Southeast Asia). Infection with the fungus Penicillium marneffei occurs in the late stages of HIV infection and occurs with fever, anemia, lymphadenopathy, hepatosplenomegaly, acute mono-, oligo- or polyarthritis, as well as multiple subcutaneous abscesses, skin ulcers, fistulas and multifocal osteomyelitis. The diagnosis of musculoskeletal infection in patients with HIV infection can be difficult for the following reasons: (1) the absence of leukocytosis in the peripheral blood and synovial fluid, especially in the later stages of HIV infection; (2) atypical location of the lesion; (3) pathogens isolated from the joint and from the blood may be different in case of polymicrobial etiology of the lesion; (4) problems with pathogen identification in the presence of previous antibiotic treatment; (5) erasure of symptoms in the later stages of HIV infection, when signs of damage to other organs and systems come to the fore in the clinical picture. It is necessary to remember the possibility of developing rheumatological syndromes in association with antiretroviral therapy, for example, zidovudine myopathy syndrome. This syndrome has an acute onset of myalgia, muscle tenderness and proximal muscle weakness after an average of 11 months. from the start of treatment. Characterized by increased concentrations of muscle enzymes in the blood serum and a myopathic type of EMG. When examining a biopsy of muscle tissue, a specific toxic mitochondrial myopathy is revealed with the appearance of “torn red fibers,” reflecting the presence of pathological mitochondrial crystalline inclusions. Cessation of treatment leads to an improvement in the patient's condition. Creatine kinase levels return to normal within 4 weeks, and muscle strength is restored within 8 weeks of discontinuation of the drug. The use of protease inhibitors can lead to rhabdomyolysis (especially in combination with statins), as well as lipomatosis of the salivary glands. Cases of the development of adhesive capsulitis, Dupuytren's contracture and dysfunction of the temporomandibular joint have been described during treatment with indinavir. Osteonecrosis and other types of bone tissue damage (for example, osteopenia, osteoporosis) are widespread among HIV-infected patients, which is due both to the disease itself and to the antiretroviral therapy performed. The most common location of aseptic necrosis is the head of the femur, damage to which (in the absence of complaints) was detected using magnetic resonance imaging in more than 4% of HIV-infected patients. Aseptic necrosis of the femoral head in 40-60% of cases is bilateral, and can also be combined with osteonecrotic lesions of another location (head of the humerus, femoral condyles, scaphoid and lunate bones, etc.). As the disease progresses, in more than 50% of cases, there is a need for surgical treatment—hip joint replacement.

HIV infection is a progressive anthroponotic disease with a predominantly contact mechanism of infection, characterized by specific damage to the immune system with the development of immunodeficiency, which is manifested by the development of opportunistic infections, malignant neoplasms, and the occurrence of autoimmune reactions.

Since the beginning of the study of HIV infection, more than 60 million people with HIV have been registered in the world. This problem is especially acute for Russia and the CIS countries, where the incidence of HIV is higher than in other regions of the world [1]. There are more than 700 thousand patients in Russia, and the estimated indicators exceed the actual detection rate by 2-4 times [2, 3].

Due to the introduction of highly active antiretroviral therapy (HAART) into clinical practice, HIV infection has moved from the category of a fatal disease to a chronic, drug-controlled disease with a human life expectancy of several decades. However, the prevalence of the disease remains high.

HIV has great genetic diversity, forming types, groups, subgroups and recombinant forms, which can (in addition to common properties) due to genetic differences acquire biological characteristics, including tropism for damage to the central nervous system, which has been the subject of active discussion in recent years [4] . In terms of the frequency of damage to various organs and systems during HIV infection, which causes acquired immunodeficiency syndrome (AIDS), the nervous system (neuroAIDS) is in second place after the immune system. This is associated with many pathogenetic mechanisms of damage to both the central and peripheral nervous systems [5]. According to autopsy data, pathomorphological changes in the nervous system occur in 70-80% of those who died from AIDS. Damage to the central nervous system during HIV infection is, as a rule, an important disabling factor. 40-60% of patients have a variety of neurological, mental and cognitive disorders, which significantly complicates their social adaptation, and in severe cases leads to complete disability.

Neurological manifestations of HIV infection can be caused by HIV itself, as well as by opportunistic infections, neoplasms, and the toxic effects of antiretroviral drugs. The direct effect of HIV on cells of the nervous system is to infect and destroy cells that have the CD4 receptor (microglial cells, astro-, mono-, oligodendrocytes, endothelial cells of blood vessels and neurons themselves) [6]. In addition, CNS cells are destroyed by the membrane protein gp 120, which plays a key role in the pathogenesis of neuronal damage by blocking neuroleukin. Various pathogenetic mechanisms can lead to clinical manifestations with a variety of neurological deficits [7].

Complex biochemical disorders play an important role in the pathogenesis of neurological disorders. Changes in the regulatory activity of the hypothalamic-pituitary system lead to disturbances in neurotransmitter metabolism, deficiency of γ-aminobutyric acid and glycine, which are associated with the development of epileptic seizures, a decrease in serotonin production leads to depressive disorders and ataxia, impaired vasopressin metabolism leads to memory disorders, damage to endothelial cells choroid plexus of the meninges and ventricular ependyma - to the development of secondary demyelination; depression of cellular immunity - to the development of opportunistic infections and neoplastic processes. As a rule, there is a combination of these factors, which determines the clinical manifestations of CNS damage in a particular patient.

Currently, a number of primary and secondary lesions of the central nervous system are identified in HIV infection:

— acquired immune deficiency syndrome, combining manifestations of infectious and degenerative processes (neuroAIDS);

— AIDS dementia syndrome;

— HIV-associated neurocognitive disorders (HAND);

— HIV-associated encephalopathy;

— HIV-related lesions of the central nervous system (primary);

— opportunistic lesions of the central nervous system [1].

Primary lesions of the nervous system in HIV include disorders associated with the direct influence of the virus: NAND, HIV-associated encephalo-, myelo-, polyneuropathies, other CNS lesions caused by HIV infection (aseptic meningitis, meningoencephalitis). HAND is a clinical diagnosis in HIV-infected patients with cognitive impairment if, based on clinical and laboratory studies, infectious and metabolic lesions of the central nervous system, depression and other causes are excluded. Establishing a diagnosis requires a holistic assessment of the patient’s virological and immune status, an assessment of the nature of the medications he is taking, drug use, analysis of concomitant diseases, as well as a neuro- and neuropsychiatric examination. HAND is not usually associated with impaired level of consciousness, focal neurological symptoms, or signs of systemic injury.

HIV-associated mild cognitive-motor disorders

occur in more than 80% of AIDS patients [8]. A neurological examination carried out in the initial stages of the disease may not reveal any abnormalities, however, neuropsychological testing, as a rule, reveals impairments in the performance of neuropsychological tests corresponding to moderate or more severe cognitive impairment. On examination, signs of diffuse symmetrical damage to the pyramidal tracts, hyperreflexia and symptoms of damage to the frontal lobes may be revealed. Detected disorders include motor and psychomotor retardation, impaired attention, inability to concentrate, mental disorders, difficulties in learning and information processing [9]. In the early stages of the disease, short-term memory suffers, which is associated with impaired memorization and retrieval of information.

HIV encephalopathy (AIDS-dementia complex), as a rule, develops in the later stages of HIV infection and has varying severity of symptoms up to the development of dementia. Syndromologically, it is a subcortical dementia that usually develops over several weeks or months. The acute development of neuropsychological symptoms indicates another cause of encephalopathy. Often the first manifestations of encephalopathy are first noticed by the patient’s relatives, and not by the patient himself. Characteristic symptoms include slowness of thinking, forgetfulness, difficulty concentrating, a feeling of loss of energy, manifestations of depression, dulling of emotions, difficulty performing fine movements (for example, when writing, fastening buttons), the appearance of an imperative urge to urinate, and erectile dysfunction.

There are several groups of symptoms of HIV encephalopathy:

1. Neurological: at an early stage they may be absent or have insignificant severity. Possible gait disturbances, slowdown in rapidly alternating movements, hypomimia, and tremor. Subsequently, there is an increase in reflexes, the appearance of pathological reflexes, a slowdown in saccadic movements of the eyeballs, pelvic disorders, and the possible development of concomitant polyneuropathy. The terminal stage is characterized by the development of spastic tetraplegia and urinary and fecal incontinence. 2. Cognitive impairment with slow psychomotor activity, disorders of short-term memory and attention switching. The dynamics of mental disorders also have a staged nature. At an early stage of the disease, increased distractibility, dullness of emotions, flattened personality traits, and lack of initiative are detected. In later stages, the patient may be disoriented in time, space and situation. As a result, mutism usually develops.

Impaired consciousness, meningeal symptoms, and focal neurological symptoms are not typical for HIV encephalopathy. Psychotic disorders (without cognitive or motor impairment) also do not meet the diagnosis of HIV encephalopathy. Rarely, such encephalopathy manifests itself with partial or generalized convulsive seizures.

The diagnosis is mostly made by exclusion. Cognitive and mental disorders are always combined with motor ones, although the latter may be mild. To identify and assess the severity of cognitive impairment in HIV encephalopathy, it is convenient to use appropriate psychometric semi-quantitative scales [10].

Laboratory and instrumental studies are aimed mainly at excluding other causes of neurological disorders. Of the neuroimaging methods, it is preferable to use MRI, which reveals signs of leukoencephalopathy (relatively symmetrical focal and diffuse changes in the density of the white matter of the brain), which never extend to the cortical parts. Sometimes there is atrophy of the brain substance with expansion of the ventricles and sulci of the cerebral hemispheres. Brain swelling, tissue compression, and contrast-enhanced MR signal enhancement are not characteristic of HIV encephalopathy and should suggest some other process, although mild symmetrical diffuse contrast enhancement of the MR signal from the basal ganglia is possible. These changes are not specific. Sometimes there are no changes on MRI. There are no focal changes on the EEG; sometimes mild signs of diffuse slowing of bioelectrical activity are detected.

Changes in cerebrospinal fluid (CSF) are nonspecific. In patients receiving highly active antiretroviral therapy (HAART), pleocytosis may be detected in the CSF, indicating an immunological response to HIV as the immune system recovers. Even before the widespread introduction of HAART into clinical practice, a weak but statistically significant relationship was established between a high viral load in the CSF and the severity of HIV encephalopathy.

Treatment of HIV encephalopathy should be aimed at suppressing HIV replication in the central nervous system, therefore the main focus of therapy is the administration of antiretroviral drugs. Preference should be given to drugs that penetrate the blood-brain barrier well. HAART led to a 2-fold reduction in the incidence of HIV encephalopathy [11, 12], while life expectancy increased from 6 to 48 months or more. The number of CD4 cells in peripheral blood during treatment increases from 50-100 per 1 μl to a normal level [13]. With HAART, significant clinical improvement in the course of HIV encephalopathy can be observed, even restoration of work ability in patients who previously required outside care. During the first months of treatment, despite significant clinical improvement, neuroimaging signs of leukoencephalopathy may increase, but gradually disappear over the next 1-2 years. It is currently believed that the presence of even minimal cognitive impairment is a sufficient basis for prescribing HAART [14]. The additional administration of nootropic and neurometabolic drugs is of an auxiliary nature, since it is not able to reduce the replication of the virus, but can help slow down the neurodegenerative processes caused by it.

Acute HIV-associated meningoencephalitis

is the most severe acute, rare form of primary CNS damage in HIV infection. Acute encephalitis is associated with direct damage to brain cells by the human immunodeficiency virus. The development of HIV meningoencephalitis coincides with or even precedes changes in the results of serological studies. At the onset of the disease, depression of consciousness (even coma) and epileptic seizures are possible. Neurological symptoms can completely regress within a few weeks, but in the future, some patients who have suffered acute meningoencephalitis may develop chronic HIV encephalopathy. A somatic examination may reveal generalized lymphadenopathy, splenomegaly, maculopapular rash, and urticaria. Nonspecific inflammatory changes in the form of pleocytosis are detected in the CSF; Neuroimaging signs of brain damage may be absent.

In the acute stage, the differential diagnosis is made with encephalitis caused by the herpes simplex virus. The latter can be excluded if, within 3 days, a repeat CT scan does not reveal brain pathology in the form of foci of low density.

The widespread use of HAART has led to an increase in the duration of the disease and made it more favorable - chronic forms of meningoencephalitis are more often observed than acute and subacute ones [15].

In 20% of HIV-infected patients, HIV-associated myelopathy often develops with severe immunodeficiency .

It can develop without the accompanying cognitive and mental disorders characteristic of HIV encephalopathy. The clinical picture is dominated by gait disturbances due to increased muscle tone of the spastic type and ataxia of the limbs, hyperreflexia, pathological reflexes, pelvic disorders, in particular erectile dysfunction. Sensitivity may be impaired in a conductive or “socks” and “gloves” type due to concomitant polyneuropathy. Isolated HIV myelopathy can be diagnosed in cases where concomitant cognitive impairment is less pronounced than the symptoms of myelopathy, or is absent. In diagnosis, the main role is given to neuroimaging methods and electrophysiological studies; an increase in the latent period of somatosensory and motor evoked potentials during transcranial magnetic stimulation is revealed. Treatment is based on HAART.

HIV-infected patients at any stage of HIV infection may develop syndromes of damage to the peripheral nervous system, which are observed in approximately ½ of patients. The most common clinical conditions are polyneuro- and polyradiculopathies, which can develop as a result of both the direct effect of HIV and opportunistic infections.

Distal symmetric sensory polyneuropathy most often develops

. It usually occurs in the later stages of HIV infection, when the number of CD4 lymphocytes becomes less than 200 per μl. The risk of its development is higher in older patients, as well as those who use narcotic drugs [16]. The connection between peripheral nerve damage and the use of neurotoxic antiviral drugs is less convincing. The disease manifests itself as slowly increasing sensory disturbances - sensations of numbness, tingling, crawling on the feet and legs. Approximately 30-50% of patients develop neuropathic pain syndrome with burning, cutting or stabbing pain in the distal extremities. Upon examination, a decrease or absence of Achilles reflexes, an increase in the threshold of vibration sensitivity on the toes, feet, ankles and a decrease in pain sensitivity in the distal extremities are revealed; proprioceptive sensitivity, as a rule, is not impaired. Weakness and atrophy of the foot muscles are mild. Hands and fingers are rarely affected. In many patients with distal symmetric sensory polyneuropathy, loss or dysfunction of small sympathetic and parasympathetic nerve fibers can cause orthostatic hypotension and erectile dysfunction. The diagnosis uses electroneuromyography, which reveals the axonal type of damage to nerve fibers.

Acute and chronic inflammatory demyelinating polyneuropathy (AIRDP and CIDP) also occur in HIV infection.

. AIDP usually develops during seroconversion or during the asymptomatic stage of HIV infection, and can rarely occur during recovery of the immune system. It occurs as Guillain-Barré syndrome. The CSF of HIV-infected patients (as opposed to HIV-negative patients) often shows mild pleocytosis. Approximately 1/3 of patients experience residual effects of varying severity.

CIDP is a chronic progressive and relapsing disease characterized by the development over several months of flaccid paresis and neuritic sensory disturbances. In some cases, relapses alternate with incomplete remissions and periods of stabilization. In CIDP, as in ARDP, protein levels in the CSF increase and mild pleocytosis is often detected. CIDP is a rare complication of HIV infection and usually develops soon after seroconversion or in the early stages of HIV infection.

Toxic drug-induced neuropathies occupy an important place among secondary lesions of the nervous system during HIV infection.

related to the prescription of antiretroviral, antimicrobial, cytostatic drugs. Approximately 10% to 30% of patients receiving didanosine, stavudine, or zalcitabine develop distal symmetric sensory polyneuropathy, which is clinically and electrophysiologically indistinguishable from polyneuropathy due to HIV infection. The only difference is a history of taking neurotoxic nucleoside reverse transcriptase inhibitors (NRTIs). Nucleoside neuropathy develops on average 12-24 months from the start of taking the drug. After its withdrawal, the condition sometimes continues to worsen for 2-4 weeks, but after 1.5-3 months it usually begins to improve. Sometimes recovery is incomplete due to the initial damage to peripheral nerve fibers caused by HIV neuropathy. With subclinical dysfunction of peripheral nerves, confirmed by electroneurography, the risk of developing neuropathy while taking NRTIs increases.

Polyneuro- and polyradiculopathies in the later stages of HIV infection can be a complication of opportunistic diseases. Multiple mononeuropathy in most cases is a complication of cytomegalovirus infection (CMV) and non-Hodgkin's lymphoma. Acute and subacute polyradiculopathy, in particular cauda equina syndrome with rapidly progressive flaccid lower paraparesis, fecal incontinence and sensory disturbances, can be caused by opportunistic infections, as well as tumor infiltration of the meninges in lymphoma. Other causes of polyneuropathy are chronic alcoholism, diabetes mellitus, exhaustion due to chronic diseases of the gastrointestinal tract, and neoplasms.

Diagnosis of neuropathies in HIV infection is usually based on anamnesis and clinical examination. To confirm the diagnosis and exclude other diseases, electroneurography is necessary. If opportunistic infections are suspected, a CSF examination is required. Sural nerve and muscle biopsy is only required in atypical cases, such as painful distal symmetric sensory ponyneuropathy in a patient with a high CD4 cell count and low viral load who is not taking neurotoxic drugs and in the absence of other risk factors. Sometimes, if there are patient complaints, an objective examination, including electrophysiological examination, does not reveal any changes. In this case, symptoms may be due to isolated neuropathy of small unmyelinated autonomic nerve fibers. To clarify the diagnosis, a puncture biopsy of the peripheral nerve with histological assessment of the density of intraepidermal nerve fibers or recording of pain-related somatosensory evoked potentials is required.

The main causes of secondary lesions of the central nervous system during HIV infection are opportunistic infections and neoplasms that develop in the later stages of HIV infection, in the stage of AIDS. Many of them often lead to the death of the patient. Toxoplasmosis is the most common cause of focal damage to the central nervous system in patients with AIDS (detected in approximately 10% of patients). In most cases it is the result of reactivation of a latent infection. Neuroimaging techniques play a crucial role in the diagnosis of toxoplasmosis. Neuroimaging reveals areas of damage to the brain substance with edema, more intense staining with intravenous contrast, often in the form of rings. Lesions are usually found in the basal ganglia. CNS toxoplasmosis in patients with AIDS often recurs after cessation of treatment, so most patients require ongoing maintenance therapy [17, 18].

Primary CNS lymphoma is detected in 5% of AIDS patients. Neurological symptoms may indicate focal or diffuse central nervous system damage. Such patients have a high titer of antibodies to the Epstein-Barr virus. When using neuroimaging methods, one (or more) hyper- or isodense lesion with signs of edema of the brain substance is identified, but the changes are not specific for lymphoma [19].

Herpesvirus complications of AIDS include damage to the central nervous system by cytomegalovirus, Herpes
zoster
, herpes simplex types 1 and 2. They can cause damage to both the brain substance and its membranes. Herpes zoster usually results from reactivation of a latent infection and occurs at different stages of HIV infection. Patients with AIDS more often have disseminated herpes and postherpetic neurological syndrome, as well as multifocal leukoencephalitis with focal or lateralized neurological symptoms and signs of hydrocephalus [20].

Tuberculosis, syphilis, and fungal infections also often lead to infectious damage to the brain and its membranes in patients with AIDS. Infectious lesions of the central nervous system are usually observed in patients with late stages of AIDS [21]. The diagnosis of these diseases is determined by the characteristics of each of them, but the infection is often verified only retrospectively, in particular in response to specific therapy. Suspicion may arise from the analysis of clinical symptoms, neuroimaging examination data, and, less commonly, from serological studies or biopsy data. There is often a co-infection with several pathogens.

Thus, neurological disorders in HIV infection are very diverse, in some cases they are the first symptoms of HIV infection and can serve as a reason for prescribing HAART.

Etiology and pathogenesis of joint pain

People who are prone to the development of rheumatic syndromes are: HIV carriers, patients with a clear clinical picture of infection, and people with total damage to the immune system (AIDS).

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What to do if you have HIV?

First of all, you need to go to a specialized specialist - a doctor at the Center for the Prevention and Control of AIDS and Infectious Diseases (they are also called “AIDS centers”). He will conduct an examination to understand whether HIV infection has become the cause of the development of various diseases. The doctor will also order a blood test, possibly to check for resistance to HIV medications. After that, he will explain to you how to proceed further.

Now there are proven ways to prevent the development of HIV infection. This is antiretroviral therapy (ART): every day at the same time you need to take 2-3 drugs that suppress the replication of the virus and improve the functioning of the immune system. Since the therapy is lifelong, and taking breaks in taking medications is dangerous, the start of treatment was previously delayed as much as possible. A few years ago, it was recommended to start therapy at a T-cell level of 350 cells/μl. The boundary was then shifted to 500 cells/μl. Now they try to ignore these indicators, since ART helps reduce the risk of developing complications of HIV infection: cancer, mental decline, heart disease, etc.

But you need to keep in mind that these are the recommendations of Western doctors. In Russia, you can hear a different opinion, which, unfortunately, often has nothing to do with science: here they are trying to delay the start of taking medications for the simple reason that the state is not able to provide for everyone in need.

What other indications are there for taking antiretroviral drugs?

Age. A person over 50 years of age will develop AIDS faster, so it is better to start ART immediately after being diagnosed with HIV infection.
Patient's wishes. If the T-cell level allows, the patient's opinion is also taken into account: if he does not want to start lifelong treatment right now, then this event is postponed. You just need to check your T-cell levels in your blood every 3-6 months and watch for warning signs (weight loss, mouth sores, etc.).
Accompanying illnesses. If a person has nephropathy due to HIV, mental deterioration, hepatitis B, hepatitis C, cardiovascular diseases, etc., then ART should be started.
Pregnancy planning. Women who are planning a pregnancy should definitely start treatment. When taking ART (except efavirenz: this drug is contraindicated in pregnant women), the amount of virus in the blood is reduced to an undetectable level, and transmission to the child becomes unlikely. A child can become infected from the mother while in the uterus, passing through the birth canal and feeding on breast milk. Therefore, it is very important that the woman is not contagious at this time.

Symptoms and course of HIV-associated arthritis

Gradually, after the onset of pain, the joint swells and the skin over it turns red.
At the initial stages, pain in the joints is perceived as manifestations of neuropathy. Only after the appearance of more serious symptoms in the form of swelling and hyperemia of the periarticular skin does a suspicion arise about the development of arthritis. The disease is inflammatory in nature and provokes disruption of venous and arterial blood flow inside the joint.

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HIV-associated arthritis

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HIV-associated reactive arthritis

In reactive arthritis, the lymph nodes become enlarged.

pain syndrome, which is more pronounced after waking up;
swelling of the joints;
hyperemia of periarticular tissues;
inflammatory reaction in other structural units;
enlarged lymph nodes due to improper blood flow;
thickening of the toes.

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Reiter's syndrome

pain in the affected joints;
formation of contracture;
inflammation of the synovial membrane;
redness of the skin;
swelling of the fingers;
heel spurs.

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HIV-associated psoriatic arthritis

In the psoriatic form of the disease, characteristic rashes are added to the joint symptoms.
Along with joint pain, skin manifestations of the disease appear. In advanced cases, severe forms of seborrhea and psoriasis develop. The disease is manifested by redness of the skin and rashes, which over time turn into erosions and become covered with a keratinized crust. Damaged areas of the epidermis become rough and compacted. Against the background of negative factors, arthritis begins acutely and progresses quickly.

The course of arthritis in HIV is divided into two groups: asymmetrical damage to large joints and symmetrical development.

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Skeletal pain syndromes in HIV

HIV arthralgia is a common manifestation of HIV infection and can occur at almost any stage of the disease, most often during the stage of primary infection. Most patients experience mild to moderate pain in one or more joints, which may be constant or migratory. The etiology is unknown, but the most likely inflammatory genesis of the disease. In some cases, acute arthralgia may develop, which lasts less than 24 hours, most often the pain is localized in the knee joint. Although symptoms may mimic septic arthritis, physical examination, diagnostic aspiration of intra-articular fluid, and radiography of the knee are usually unremarkable. The disease is self-limiting.

HIV arthritis is described as a self-limited subacute oligoarthritis, the manifestations of which can last from 1 week to 6 months.

Patients note the appearance of acute pain in the joints, most often in the knee or ankle joints. Biopsy of synovial tissue reveals chronic mononuclear cell infiltration. It is believed that the disease may be caused by direct exposure of the HIV virus to synovial tissue or by exposure of the synovium to reactive immune complexes. Therapy may include intra-articular injections of corticosteroids or NSAIDs; It may be necessary to prescribe opioids for pain control.

Acute symmetrical polyarthritis is similar to rheumatoid arthritis. Upon examination, ulnar deviation and “swan neck” deformations of the hands are revealed; X-ray shows narrowing of the intraarticular space and periarticular osteopenia. However, unlike rheumatoid arthritis, the onset of the disease is often acute and radiological changes appear quite early; rheumatoid factor negative.

Reactive arthritis, or Reiter's syndrome, occurs more often in HIV-infected patients than in immunocompetent individuals, the incidence of this disease reaches 5-10% in the population of HIV-infected patients. The etiology is not entirely clear, but reactive arthritis is thought to be associated with the HLA-B27 antigen, and there is also evidence suggesting an association with certain bacterial pathogens, such as Yersinia, Campylobacter and Shigella.

Reiter's syndrome consists of a triad: arthritis, conjunctivitis and urethritis, but the complete triad is not common. In many patients, the joints of the foot and ankle are involved, and the joints of the hands and other large joints may also be affected. In some patients, the disease is mild and resolves spontaneously; in other cases, severe arthritis may develop, affecting multiple joints and fever. Other connective tissue structures, such as tendons and fascia, may also be involved in the pathological process. Achilles tendonitis, rotator cuff tendinitis and de Quervain's tenosynovitis may develop. Some patients develop the most serious symptom, called “AIDS foot”, which includes damage to the Achilles tendon, tibialis anterior and posterior tendons, digital extensor tendons and plantar fascia. These patients walk with their feet wide apart and without ankle flexion to reduce painful stress on the heels. Uveitis, ulcers on the oral mucosa, damage to the head of the penis, and multifocal skin hyperkeratosis may also develop. NSAIDs are recommended as basic therapy, and opioids may be prescribed to treat pain.

Reactive arthritis can sometimes be difficult to differentiate from psoriatic arthritis, a clinically similar disease that occurs in 2-3% of HIV-infected patients. Psoriatic arthritis is often, but not always, accompanied by skin lesions characteristic of psoriasis, including isolated and confluent, round maculopapular rashes of red color, covered with silvery scales, localized primarily in the area of the elbows and knees, on the scalp and torso. Dystrophic changes in the nails (formation of dimples on the nail plate) are also often observed. Treatment is similar to that for reactive arthritis.

Hypertrophic osteoarthropathy is characterized by severe pain in the lower extremities, often in combination with lesions of the toes (club-shaped lesions), swelling (without pitting when pressure is applied), and joint pain. The skin over the affected areas appears swollen, shiny and hot to the touch. X-rays reveal periosteal and subperiosteal changes in long bones. The disease may be associated with an infectious lung infection, most often with pneumonia caused by Pneumocystis jiroveci. The condition usually improves with treatment of opportunistic infections.

Septic arthritis is an acute bacterial joint infection that is common in HIV-infected patients. Risk factors include hemophilia, drug injections and homosexual orientation in men. Patients complain of pain in one of the joints and fever; examination results suggest septic arthritis; diagnostic aspiration of intra-articular fluid can help in the differential diagnosis of the disease. The most common pathogen is S. aureus, but the disease can be caused by other pathogens. The hip and knee joints are most commonly affected; however, in HIV-infected patients, unusual lesion locations may occur, such as the sternoclavicular joint.

Septic bursitis is an infectious lesion of the periarticular bursa; usually the pathological process is localized in the olecranon bursa and in the prepatellar bursa. Plain radiography and MRI help in diagnosing the disease. Treatment includes antibiotic therapy, surgical debridement and drainage.

Osteomyelitis is a progressive infection of the bones and often occurs in HIV-infected patients in the later stages of the disease. Patients usually complain of the sudden onset of fever (with a rise in temperature to febrile levels), chills, pain and tenderness in the area of the affected bone. The pathological process most often involves the spine and long tubular bones. Additional risk factors include drug injections and vascular insufficiency. An increase in ESR is noted. Blood cultures and bone aspiration may help determine the etiology of the disease. Plain radiographs are usually normal early in the disease, but early signs of disease (which may occur as early as 2 weeks after onset) may include periarticular bone demineralization; erosive changes in bone tissue and periosteal reaction. MRI is the most sensitive diagnostic method, especially when soft tissue damage is suspected. A radionuclide bone scan can reveal multifocal areas of infection. The most common pathogen is S. aureus, but many other organisms can cause osteomyelitis, including. tuberculosis. The greatest danger is tuberculous osteomyelitis, so this diagnosis should be excluded in all HIV-infected patients with suspected osteomyelitis. Treatment of osteomyelitis is complex and involves narrow-spectrum antibiotic therapy (depending on the causative agent), administered over a long period of time (often parenterally), and surgical drainage.

Osteonecrosis or avascular neurosis is the pathological destruction of bone tissue as a result of vascular disorders. Osteonecrosis is more common in HIV-infected patients than in immunocompetent individuals, with an incidence reaching 4-5% in this population. The exact cause of the vascular abnormalities causing osteonecrosis in HIV-infected patients is unclear. In recent years, the use of protease inhibitors has been associated with an increased risk of osteonecrosis of the femoral head, the mechanism of which is still unclear. In patients with osteonecrosis, the most common symptom is intermittent, deep, throbbing pain. The pain can come on suddenly or gradually and is often associated with stress on the affected area. However, pain can also occur at rest in advanced stages of the disease, and in some patients with osteonecrosis, pain does not appear until late in the disease. Pain is often localized in the hip joint, but can also occur in the knee, shoulder, ankle and wrist; in many cases, damage to several joints is simultaneously detected in one patient. X-rays, CT scans and bone scans can help diagnose this pathology, but MRI is the most sensitive diagnostic method. In the early stages of the disease, therapy includes reducing the load on the affected joint in order to slow the progression of the pathological process. As the disease progresses, surgery may be required for revascularization, stabilization, or joint replacement. Increased pain as the disease progresses may require intensive pain therapy.

HIV

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Other joint lesions

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What is the prognosis for joint pain and HIV?

Content

conclusions

Pain is a common symptom of HIV. Pain can result from the virus itself, as well as complications from HIV and side effects from its treatment.

The pain can be relieved, but this requires an individual approach. The doctor can help the patient determine the cause of the pain and recommend a treatment plan. This may include adjusting current HIV treatments or prescribing pain medications.

Home remedies and alternative treatments such as acupuncture and massage can also help treat pain.

The authors of another study believe that a mobile phone will help detect HIV infection.

What kind of pain can HIV infection cause?

Already in the early stages of the infection, muscle soreness appears (characteristic is aching muscle pain). This is a consequence of damage to muscle tissue. It is observed in 1/3 of all infected people. Primary muscle damage is called myopathy. Movements become constrained and cause discomfort. The extreme degree of tissue damage is polymyositis. A person becomes disabled. He is practically immobilized, the slightest dynamics causes suffering.
With HIV infection, changes affect all components of the musculoskeletal system. Patients have pain in the spine, joints, and aching bones. More than half of the carriers complain of such sensations. The virus primarily affects large joints:

hip;
shoulder;
elbows;
knee

weakness;
body aches;
rise in temperature;
enlarged lymph nodes.

BUZ UR "URC AIDS and IZ"

HIV (human immunodeficiency virus) is the virus that causes AIDS. HIV attacks the immune system, destroying white blood cells that help the body fight infection and disease. The test is the only reliable way to determine whether you have HIV. The following are symptoms that may be a warning that you have an infection.

Method 1 of 3: Identifying Early Symptoms

Determine whether you experience extreme fatigue without an explainable reason.
Fatigue can be a sign of a wide variety of illnesses, and is also a symptom in people living with HIV. This symptom shouldn't cause you more concern if it's the only one you feel, but it's worth thinking about in the future.

— Severe fatigue is not a feeling when you just want to sleep. Do you feel tired all the time, even after getting a good night's sleep? Do you take naps during the day more often than usual and avoid strenuous activities because you feel low on energy. This type of fatigue is a cause for concern.
- If such a symptom persists for more than several weeks or months, you should undergo testing to rule out HIV.

Monitor your temperature or excessive night sweats.

These symptoms often occur in the early stages of HIV, during what is called the primary or acute stage of HIV infection. Again, many people do not have these symptoms, but those who do usually feel them 2-4 weeks after contracting HIV.

— Fever and increased sweating are symptoms of the flu and the common cold. If it's a cold season or a flu epidemic, you may be sick with these diseases.
— Chills, muscle pain, sore throat and headache are also symptoms of flu and colds, but can also be signs of early HIV infection.

Check for swollen tonsils in the throat, as well as lymph nodes in the armpits and groin.

Lymph nodes become swollen as a result of infection. This does not happen to everyone who has early HIV, but among those who do, these are the most common symptoms.

— With HIV infection, the lymph nodes in the neck usually swell more than the nodes in the armpits and groin.
- Lymph nodes can become swollen as a result of other types of infections such as colds and flu, so further testing is necessary to make a diagnosis.

Be aware of cases of nausea, vomiting and diarrhea.

These symptoms may also be a sign of early HIV infection. Get checked if such symptoms persist for a long time.

Pay attention to sores in the mouth and genitals.

If mouth ulcers occur along with other symptoms already mentioned, and especially if you have not usually had mouth ulcers before, this may be a sign of early HIV infection.
Ulcers on the genitals are also a sign that HIV infection may have occurred. Method 2 of 3: Identifying Progressive Symptoms

Don't rule out a dry cough.

This symptom occurs in the later stages of HIV, sometimes even for many years after infection, when the virus was latent in the body. This seemingly harmless symptom is easy to miss at first, especially if it occurs during allergy or flu season or during the cold season. If you have a dry cough and cannot get rid of it with antihistamines or an inhaler, this could be a sign of HIV.

Look for unusual spots (red, brown, pink or purple) on the skin.
People in the later stages of HIV often have a skin rash, especially on the face and torso. The rash may be inside the mouth or nose. This is a sign that HIV is turning into AIDS.

— Flaky, red skin is also a sign of late stage HIV. The spots can be in the form of boils and bumps.
— A rash on the body is usually not accompanied by a cold or fever. Accordingly, if you alternately experience such symptoms, consult a doctor immediately.

Pay attention to pneumonia.

Pneumonia often affects those whose immune systems are weakened for various reasons. People with late-stage HIV are more likely to get pneumonia when exposed to germs that don't usually cause such a serious reaction.

Check for thrush, especially in the mouth.

The last stage of HIV usually causes thrush in the mouth, called stomatitis. It appears as white or other unusual spots on the tongue or inside the mouth. This is a warning sign that the immune system cannot effectively fight the infection.

Examine your nails for fungus.

Yellow or brown nails that are cracked or chipped are a common sign of late-stage HIV. Nails become more susceptible to fungi, which the body is normally able to fight off.

Determine if you are experiencing rapid weight loss for an unknown reason.

In the early stages of HIV, this can be caused by severe diarrhea; in later stages, it can be caused by “atrophy,” a strong reaction of the body to the presence of HIV in the body.

Be careful with cases of memory loss, depression or other neurological problems.

In the final stages, HIV affects the cognitive functions of the brain.
These symptoms are serious in themselves and should be investigated in any case. Method 3 of 3: HIV Data
1

Find out if you are at risk.

There are several conditions that put you at risk of contracting HIV. If you experience such situations, then you are at risk:

— You had unprotected anal, vaginal or oral sex.
— You shared needles and syringes with other people.
- You have been diagnosed or treated for sexually transmitted diseases (STDs), tuberculosis, or hepatitis.
“You received a blood transfusion between 1978 and 1985, these are the years before they started testing blood to prevent the transfusion of contaminated blood.

Don't wait until symptoms appear to get tested.

Many people with HIV do not know they have it. The virus can remain in the body for more than 10 years before symptoms appear. If you have reason to suspect that you have been infected with HIV, do not refuse testing because you have no symptoms.

Take an HIV test.

This is the most accurate method for detecting HIV. Contact us at: Izhevsk, st. Truda 17a, tel. or to one of our zonal centers located in the cities of Glazov, Votkinsk, Sarapul, Mozhga, as well as in the villages of Uva and Igra.

— Testing is simple and absolutely FREE.
— If you have been tested for HIV, do not let fear prevent you from getting the test results. Information about whether you are infected or not will change your lifestyle or way of thinking.

Adviсe

— If you are in doubt about whether to do the analysis or not, do it. This is the only correct and safe action for both you and others.
— HIV is not transmitted by airborne droplets or food. This virus does not live long outside the body.

Sore throat

With HIV, the patient often has a sore throat. Soon after infection, a sore throat may be caused by:

lesions of the oral mucosa,
various throat infections.

The negative impact of the human immunodeficiency virus on the ENT organs increases over time. At the stage of AIDS, sore throats that occur in severe forms cause a lot of trouble to the patient.