ab22313

Osteoarticular mycobacterial infections in patients with the human immunodeficiency virus

J. Belzunegui, M. Santisteban¹, M. Gorordo¹, E. Barastay, C. Rodríguez-Escalera, L. Lopez-Dominguez, C. Gonzalez, M. Figueroa

Rheumatology Unit, Hospital Donostia (San Sebastian) and Hospital Basurto¹, Bilbao, Spain.

ABSTRACT
Objective
Data about the characteristics of patients with the human immunodeficiency virus (HIV) and concomitant mycobacterial skeletal infection are scarce. Thus, our aim was to describe this condition in a cohort of 11 patients.

Methods
A review of the records of 11 HIV-positive individuals with microbiological confirmation of mycobacterial osteoarticular infection was conducted. The studied data included: age, sex, risk factor for the HIV, days between the onset of symptoms and diagnosis, evidence of previous tuberculosis, location of the infection, isolated organism, diagnostic method, laboratory data (erythrocyte sedimentation rate, haemoglobin, leukocyte count), number of CD4+ lymphocytes, anti-retroviral therapy, treatment and outcome.

Results
Eight patients were men and 3 were women. The median age was 34.2 years (range 20-46 years). Previous tuberculosis was present in 5 cases. Mean days between the onset of symptoms and diagnosis was 124 (range 20-365 days). Infections involved the knee (4 cases), spine (3 cases), hip (2 cases), elbow (1 case) and tibia (1 case). ESR was frequentley elevated. The CD4 count ranged from 0.03 to 0.779 x 109/l (mean 0.245 x 109/l). M. tuberculosis was the responsible organism in 9 cases, Mycobacterium tuberculosis plus Staphylococcus aureus in one case and M. Kansasii in one case. Patients received specific treatments with good results. Surgery was necessary in 4 cases. No deaths occurred. Four patients were anti-retroviral naive at the moment the diagnosis was made. The remainder 8 were on zidovudine therapy.

Conclusion
The immunologic status of patients with HIV and concomitant mycobacterial skeletal infections is quite variable. The outcome of this condition seems to be good.

Key words
Tuberculosis, HIV, skeletal, osteoarticular.

Please address correspondence to: Dr J. Belzunegui, Rheumatology Unit, Hospital Donostia, P. Dr. Beguiristain s/n, 20014 San Sebastian, Spain.