Foot pain in those with HIV

NewsBot · Feb 21, 2015

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Is HIV Painful? An Epidemiologic Study of the Prevalence and Risk Factors for Pain in HIV-infected Patients.
Lawson E, Sabin C, Perry N, Richardson D, Gilleece Y, Churchill D, Dean G, Williams D, Fisher M, Walker-Bone K.
Clin J Pain. 2014 Oct 17

OBJECTIVES::
To evaluate the prevalence, impact and risk factors for pain among a cohort of HIV-infected adults treated with combination anti-retroviral therapy (cART) if indicated according to current guidelines.
METHODS::
This was a cross-sectional epidemiological observational study. All patients attending one HIV-outpatient centre in the UK in a 10-month period were eligible. Patients completed a validated questionnaire enquiring about demographics, HIV factors and symptoms of pain.
RESULTS::
Of 1050 eligible participants, 859 (82%) completed a questionnaire. The 1-month period prevalence of pain lasting >1 day was 62.8% amongst whom 63% reported current pain. The prevalence of pain at most anatomical sites was broadly similar to that observed in population studies using the same questionnaires except that we found considerably higher rates of foot/ankle pain. The median duration of pain was 3 years (range 0-51 y) and the median pain score was 5.0 on an 11-point visual analogue score. Over 40% of people in pain had consulted their primary care physician and >20% were taking analgesics daily. Independent risk factors for current pain were older age (P=0.001), time since diagnosis of HIV infection (P=0.001) and receipt of a protease inhibitor-based regimen (P=0.04).
DISCUSSION::
Pain, and notably foot/ankle pain, is common among adults living with prevalent HIV and is associated with substantial morbidity and healthcare utilisation.
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Admin2 · Oct 22, 2014

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NewsBot · Feb 21, 2015

An interesting case of ‘diabetic foot ulcer’ in an HIV-positive patient
Venkat Sivaprakasam; Catherine Chima-Okereke
Int J STD AIDS March 2015 vol. 26 no. 4 285-287

Kaposi sarcoma is a highly vascularised tumour affecting the skin, lymph nodes and viscera. Kaposi sarcoma is most common in HIV-infected homosexual or bisexual men. We present here a 70-year-old white British male patient, who was under the care of the podiatric team for longstanding ‘diabetic foot ulcers’. He was later referred to the Dermatology team who took a biopsy; this revealed features of Kaposi sarcoma which prompted an HIV test which was positive. This patient had previously presented to several healthcare professionals with symptoms suggestive of HIV infection. He was started on antiretroviral therapy and the HIV and human herpesvirus-8 viral loads became undetectable in the blood within weeks and he showed significant clinical improvement. This case report is a reminder to clinicians to have a high index of suspicion in patients presenting with symptoms and signs suggestive of HIV infection.
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NewsBot · Mar 5, 2016

Inflammatory arthritis in HIV positive patients: A practical guide
T. Adizie, R. J. Moots , B. Hodkinson, N. French, A. O. Adebajo
BMC Infectious Diseases 01 March 2016

Background
Musculoskeletal manifestations of the human immunodeficiency virus (HIV) have been described since the outset of the global HIV epidemic. Articular syndromes that have been described in association with HIV include HIV-associated arthropathy, seronegative spondyloarthropathies (SPA) (reactive arthritis, psoriatic arthritis (PsA) and undifferentiated SPA), rheumatoid arthritis (RA) and painful articular syndrome.
Methods
We carried out a computer-assisted search of PubMed for the medical literature from January 1981 to January 2015 using the keywords HIV, acquired immune-deficiency syndrome, rheumatic manifestations, arthritis, spondyloarthropathy, anti-TNF and disease modifying antirheumatic drugs. Only English language literature was included and only studies involving adult human subjects were assessed.
Results
There are challenges in the management of inflammatory arthritis in patients who are HIV-positive, including difficulties in the assessment of disease activity and limited information on the safety of immunosuppressive drugs in these individuals.
Conclusions
This review focuses on the clinical characteristics of the inflammatory articular syndromes that have been described in association with HIV infection and discusses the therapeutic options for these patients.
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NewsBot · Apr 9, 2016

Clinical and Laboratory Predictors of Articular Disorders Among HIV-infected Patients Seen at Teaching Hospital Southeast Nigeria.
Okwara CC, Ozoh G, Nwatu BC
Ann Med Health Sci Res. 2015 Nov-Dec;5(6):447-53

BACKGROUND:
HIV infection may be associated with different arthropathies that are often underdiagnosed. There is also paucity of reported studies of relationship between clinical and laboratory features of HIV-infected patients and articular disorders.
AIMS:
To determine the predictors of articular disorders among HIV-infected patients seen at tertiary hospital Nigeria.
SUBJECTS AND METHODS:
Hospital-based cross-sectional descriptive study. Subjects were recruited from outpatient clinics of the study centers. Persons aged 16 years and above were recruited via stratified sampling method. Subjects with trauma, degenerative arthritis, malignancy, hepatitis B surface antigen and anti-hepatitis C virus positivity or previously known to have pulmonary tuberculosis or rheumatological disorders were excluded. Pretest-improved semi-structured questionnaire was administered to the recruited 480 subjects comprising 240 HIV positive subjects (HPS) and 240 HIV-negative subjects (HNS). Blood for relevant laboratory tests and radiographs were done where necessary. Diagnosis of articular disorder was based on American College of Rheumatology and European Spondyloarthropathy Study Group classification guidelines. Statistical Package for Social Sciences version 15 (SPSS Inc., Chicago, IL, USA) was used for data entry, validation, and analysis.
RESULTS:
Of the 480 participants, both HPS and HNS were made up of 95 males and 145 females. There was statistically significant difference between the frequency of occurrence of articular disorders among the HPS of 37.1% (89/240) and the HIV-negative controls of 16.2% (39/240) (χ(2) = 26.63 P = <0.01). Arthralgia frequency of 29.6% (71/240), HIV-associated arthritis 4.6%, (11/240) (Reiter's disease 1.3% (3/240), undifferentiated spondyloarthropathy 1.3%, (3/240) and gout 0.4% (1/240) (were seen among the HPS. Only arthralgia was found among HNS. Erythrocyte sedimentation rate (ESR) and age were the best predictors of arthralgia presence. CD4+ T-cell count was predictive of HIV-associated arthritis.
CONCLUSIONS:
Articular disorders are commoner among HIV patients than HNS. ESR and age were the best predictors of Arthralgia presence among HIV-infected patients. CD4+ T-cell count was predictive of HIV-associated arthritis.
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NewsBot · Mar 18, 2019

Variations in plantar pressure and balance in HIV-infected children in antiretroviral therapy.
da Silva Pontes L et al
Sci Rep. 2019 Mar 13;9(1):4344

Balance disorders have been poorly investigated and somewhat neglected in people infected with the human immunodeficiency virus, especially in children, whose have intrinsic and extrinsic risk factors that may compromise the balance. To evaluate the foot plantar pressures and the balance in children with acquired immunodeficiency. We recruited 53 children aged between 6 and 15 years: 33 healthy children, and 20 children with positive serology for the human immunodeficiency virus. A physical examination included anthropometric, reflexes, tactile sensitivity of the foot and orthopedic evaluation. We also collected data of them using Pediatric Equilibrium Scale, baropodometry, and stabilometry. We considered significance level of 0.05 for statistics. Both groups were aged-, sex-matched and similar body mass index and scores of the Pediatric Equilibrium Scale. Three infected children had altered tactile sensitivity, and none had orthopedic or reflex alteration. Infected children had higher mean plantar pressure in the hindfoot than of the control group (p = 0.02). There was higher maximum plantar pressure in the hindfoot of the infected children than of the controls (p = 0.04). Controls had lower maximum plantar pressure in the forefoot than the infected children (p = 0.04). Infected children had larger displacement of the center of pressure (p = 0.006), larger mean velocity of displacement (p = 0.006), and longer duration between successive peaks of displacement than the controls (p = 0.02). Children living with the human immunodeficiency virus discharges great plantar pressures in the hindfoot and to present balance disturbances in the absence of neurological symptomatology.
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