الفهرس 
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Abstract
The human immunodeficiency virus (HIV) is a lentivirus (a subgroup of retrovirus) that is able to persist in the form of integrated proviruses in a predominantly CD4 T cell reservoir causing HIV infection and over time acquired immunodeficiency syndrome (AIDS).
AIDS is a condition in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive leading to huge burdens to person, family and community Egypt is classified as having a low prevalence of HIV/AIDS, WHO has estimated the national prevalence of HIV infection in Egypt by <0.01 in the year 2019. Many prevention programs specifically for IDUs existed in Egypt, including harm reduction programs such as needle exchange and methadone maintenance.
The incidence of rheumatic manifestations in HIV infection was reported to be much more prevalent in HIV patients than the HIV negative population, also unrelated rheumatologic disorders whose course have been altered by HIV infection.
Risk factors such as unsafe sexual practices and intravenous drug use are associated with HIV infection and certain rheumatic diseases. Rheumatic manifestations in HIV infection include body ache, arthralgia, painful articular syndrome, reactive arthritis, HIV-associated arthritis, rheumatoid arthritis, undifferentiated spondyloarthropathy, systemic lupus erythematosus (SLE), fibromyalgia, septic arthritis, acute gout, avascular bone necrosis, osteoporosis, osteomyelitis, hypertrophic osteoarthropathy, polymyositis, dermatomyositis, pyomyositis, Sjogren’s syndrome, diffuse infiltrative lymphocytosis syndrome (DILS), vasculitis, Kaposi’s sarcoma, and lymphoma.
HAART therapy may exacerbate certain inflammatory and autoimmune diseases such as SLE, rheumatoid arthritis, and polymyositis or even may develop de novo may be due to immune restoration.
This study was observational cross sectional study conducted in tertiary hospital of infectious diseases in Giza, Egypt outpatient clinics and inpatient departments. It included one hundred human immune deficiency virus infected Egyptian patients diagnosed according to national AIDS program criteria having an immunological or a musculoskeletal disorder with age of ≥ 18 years.
Full medical history was obtained from all participants. Full examination including chest, heart, abdomen, and neurological examination with through rheumatological examination using the GALS screening system for rheumatological disorders.
All participants subjected to laboratory investigations including CBC, ESR, CRP, Serum uric acid, Kidney function tests (blood urea and serum creatinine), ALT, AST, RF, ANA, HIV antibody by ELISA confirmed by western blot method.
In our study, males represented the majority of cases with higher incidence in age group 25-35 years. The most frequent risk factor for acquiring infection was unsafe sex followed by IV drug abuse and unknown risk factor, then tattooing, then surgical operations and frequent blood transfusion. HIV is most prevalent in high-risk groups including street children, female sex workers (FSWs), men who have sex with men (MSM), and injecting drug users (IDUs).
The most common comorbidity was infections such as T.B and neurological diseases followed by hypertension and cardiac diseases then, diabetes mellitus, lung diseases, renal diseases and gastrointestinal diseases. HIV-infected TB patients are at higher risk for MDR-TB.
Within our patients the most commonly joint affected was the knee joint followed by sacroiliac joint, proximal inter phalangeal (PIP) joints of the hand, the metatarsophalangeal (MTP) joints, shoulder joints, cervical spine then metacarpophalangeal (MCP) joints.
The most common clinical manifestations within our patients were arthralgia followed by myalgia, Raynaud’s phenomenon, arthritis, painless oral ulcers, and thromboembolic manifestations.
There was a highly significant increase in the percentage of arthralgia and oligoarthritis in HIV positive patients on HAART but, there was a highly significant increase in presence of Raynaud’s phenomenon and thromboembolic manifestations in HIV positive patients not receiving HAART besides painless oral ulcers.
In our patients there were a high significant positive correlation between the HIV-PCR level and skin malignancy (Kaposi sarcoma), lymphadenopathy and hepatomegaly.
Results from our study which revealed a highly significant correlation between both CD4 count, HIV-PCR level and the incidence of oral ulcers. There were only a significant value between HIV-PCR level and the presence of myositis or thromboembolic manifestations.
Within our 100 HIV positive patients the mean levels of ESR, CRP and SGOT levels were elevated. There was a weak inverse correlation between the CD4-positive lymphocyte count and ESR.
There were a highly significant negative correlation between CD4 count and HIV infection duration ESR, CRP, urea, creatinine, blood urea level, SGOT, SGPT. Also, significant negative correlation between CD4 count and uric acid level.
Moreover, there were a highly significant positive correlation between the HIV-PCR level and ESR, CRP, serum creatinine level, SGOT and SGPT. There were a high significant negative correlation between the HIV-PCR level and hemoglobin level, platelets count and CD4 count. There was a significant negative correlation between HIV-PCR level and absolute lymphocyte count.