Rheumatic Involvement in HIV: An Evolving Clinical Spectrum

Abstract

Human Immunodeficiency Virus (HIV) infection has evolved from a fatal infectious disease into a chronic manageable condition due to advances in antiretroviral therapy (ART). Consequently, rheumatic and musculoskeletal manifestations have emerged as important causes of morbidity and reduced quality of life among HIV-infected individuals. These manifestations include inflammatory arthropathies, reactive arthritis, psoriatic arthritis, septic arthritis, myopathies, vasculitic syndromes, and pain disorders. Clinical presentations are often atypical and may mimic autoimmune or infectious conditions, creating significant diagnostic challenges. Immune dysregulation, chronic inflammation, opportunistic infections, and ART-related effects contribute to disease pathogenesis. Accurate diagnosis requires careful clinical assessment supported by imaging and laboratory investigations. Management involves balancing immunosuppressive therapy with preservation of immune function, while optimizing ART remains central to treatment. Primary care physicians play a vital role in early recognition, multidisciplinary coordination, and long-term management, ultimately improving patient outcomes and overall quality of life.