Dr. Ira Shah*
In charge, Pediatric HIV Clinic, B.J. Wadia Hospital for Children, Parel, Mumbai 400012 *
HIV-associated arthropathy has been rarely reported from the Indian subcontinent and even less frequently in HIV infected children. HIV associated arthropathy has been reported in HIV infected adults both from the western and African countries. The precise cause of these spondylarthropathies in HIV infection is still unclear, however demonstration of HIV antigen in the synovial membranes suggests a direct role of HIV in the pathogenesis of HIV-infected patients and response to antiretroviral therapy (ART) may be variable. We report an HIV infected child who presented with seronegative spondylarthropathy and had excellent response to antiretroviral therapy.

A 12 years old boy had polyarthralgia, myalgia and dysphagia especially for solids with intermittent fever for the past 2 months for which he was treated with multiple NSAIDS but had no relief. He had herpes zoster over the left thigh 3 months back. He had been treated for Pulmonary Koch's 1 year back for 9 months and had tested positive for HIV ELISA at that time. He had also received a blood transfusion 1 year back. Both parents were HIV positive. On examination, he was malnourished and had generalized lymphadenopathy. He had joint contractures in both knees with decreased joint movements at the shoulder, elbow, wrist and ankle joint. There was no joint swelling or redness. He also had restricted pronation and supination and restriction of movement at the temporo-mandibular joint. Flexion at the cervical spine was restricted. On systemic examination, he had splenomegaly. His RA factor, Antinuclear antibody and Double stranded DNA were negative. His HBsAg & Anti HCV were negative. His CD4 count was 238 cells/cu mm with CD4 percentage of 17.9% suggestive of severe immune suppression. He was started on 3 drug antiretroviral therapy (ART). After 1 month of ART, joint movements improved and NSAIDs were stopped. At the last follow-up after 3 months of ART, he had gained 3 kg weight, had no dysphagia or fever and all joint except both knees had achieved full range of movements.
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