title: Musculoskeletal and autoimmune manifestations of HIV, syphilis and tuberculosis.
abstract: OBJECTIVE
  The HIV pandemic continues to increase at an alarming rate, and is the leading cause of death worldwide from a single pathogen. The number of HIV-1-infected individuals currently exceeds 40 million, the majority of whom live in the developing countries of Asia, sub-Saharan Africa and south America. In the past 5 years, there has concurrently been an increase in the reported cases of tuberculosis and primary and secondary syphilis. This review addresses the musculoskeletal and autoimmune manifestations associated with HIV, syphilis and tuberculosis infections or their treatments.
  
  
  RESULTS
  During HIV infection the immune system becomes dysfunctional because of the coexistence of immunodeficiency and immune hyperactivity, and a disregulated production or activity of cytokines. Some of these mechanisms explain the development of rheumatic manifestations associated with HIV infection. Highly active antiretroviral therapy changes the course of HIV infection and the spectrum of the HIV-associated rheumatic manifestations. New syndromes such as the immune reconstitution inflammatory syndrome have emerged. HIV, tuberculosis and syphilis infections offer special epidemiological, clinical, and therapeutic challenges.
  
  
  CONCLUSIONS
  These observations highlight the complexity and multiplicity of the interactions between the pathogen and host that could result in the development of rheumatic manifestations.
authors.affiliation: Section of Rheumatology, Department of Medicine, Louisiana State University Health Sciences Center, Tulane University Health Sciences Center, New Orleans, Louisiana 70112, USA.
authors.forename: Ines
authors.initials: I
authors.lastname: Colmegna
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Koehler
authors.forename: Robert F
authors.initials: RF
authors.lastname: Garry
authors.forename: Luis R
authors.initials: LR
authors.lastname: Espinoza
mesh_terms: D001327:Autoimmune Diseases / Q000276:immunology*; D015658:HIV Infections / Q000150:complications / Q000276:immunology*; D006680:HLA Antigens / Q000276:immunology; D006801:Humans; D012216:Rheumatic Diseases / Q000276:immunology*; D013587:Syphilis / Q000150:complications / Q000276:immunology*; D014376:Tuberculosis / Q000150:complications / Q000276:immunology*
chemical_list: D006680:HLA Antigens