title: Effect of human immunodeficiency virus infection on disease activity in rheumatoid arthritis: a retrospective study in South Africans.
abstract: OBJECTIVE
  To determine the effect of human immunodeficiency virus (HIV) infection on disease activity in rheumatoid arthritis (RA).
  
  
  METHODS
  A retrospective records review of patients who contracted HIV infection subsequent to RA diagnosis (HIV group), compared to an HIV-negative group of patients with RA (control group), for 28-joint Disease Activity Score (DAS28) scores at initial presentation (T0) and last clinic visit (TL), and at diagnosis of HIV infection (TH) in the HIV group.
  
  
  RESULTS
  Of 1712 patients with RA, 85 were HIV-positive (4.9%), 43 of them contracting HIV subsequent to RA diagnosis. The mean (SD) age, RA disease duration, and duration following diagnosis of HIV were 47.1 (10.1), 10.5 (8.4), and 2.9 (2.0) years, respectively, for the HIV group. Both the HIV and control groups showed similar improvement in joint counts and C-reactive protein (CRP) at visit TL, in spite of methotrexate (MTX) being withdrawn in most patients in the HIV group by visit TL (11.6% in the HIV group were still taking MTX vs 83.7% in the control group, p = 0.0002), but a minority (13.9%) had ongoing moderate to high disease activity at visit TL. In the HIV group, the mean DAS28-erythrocyte sedimentation rate (ESR) and DAS28-CRP scores were similar at baseline, but at visits TH and TL the mean DAS28-ESR scores were significantly higher than the mean DAS28-CRP scores (31% and 31.8%, p < 0.0005 and p < 0.004, respectively), mainly resulting from ESR increase following HIV seroconversion.
  
  
  CONCLUSIONS
  Disease activity improved in most patients in the HIV group in spite of stopping the MTX as the "anchor drug." The DAS28-ESR overestimates disease activity compared to the DAS28-CRP in the setting of HIV infection.
authors.affiliation: From the Division of Rheumatology, Department of Internal Medicine, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.G. Tarr, MBBCh, FCP (SA), MMed; M. Makda, MBBCh, FCP (SA), MMed; E. Musenge, MSc, PhD; M. Tikly, MBBCh, MMed, FRCP, PhD, Division of Rheumatology, Department of Internal Medicine, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand.
authors.forename: Gareth
authors.initials: G
authors.lastname: Tarr
authors.affiliation: From the Division of Rheumatology, Department of Internal Medicine, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.G. Tarr, MBBCh, FCP (SA), MMed; M. Makda, MBBCh, FCP (SA), MMed; E. Musenge, MSc, PhD; M. Tikly, MBBCh, MMed, FRCP, PhD, Division of Rheumatology, Department of Internal Medicine, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Makda
authors.affiliation: From the Division of Rheumatology, Department of Internal Medicine, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.G. Tarr, MBBCh, FCP (SA), MMed; M. Makda, MBBCh, FCP (SA), MMed; E. Musenge, MSc, PhD; M. Tikly, MBBCh, MMed, FRCP, PhD, Division of Rheumatology, Department of Internal Medicine, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand.
authors.forename: Eustasius
authors.initials: E
authors.lastname: Musenge
authors.affiliation: From the Division of Rheumatology, Department of Internal Medicine, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.G. Tarr, MBBCh, FCP (SA), MMed; M. Makda, MBBCh, FCP (SA), MMed; E. Musenge, MSc, PhD; M. Tikly, MBBCh, MMed, FRCP, PhD, Division of Rheumatology, Department of Internal Medicine, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand. mohammed.tikly@wits.ac.za.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Tikly
mesh_terms: D000328:Adult; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology; D015415:Biomarkers / Q000097:blood; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000378:metabolism; D016022:Case-Control Studies; D004185:Disability Evaluation; D005260:Female; D006678:HIV; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013019:South Africa / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein
keywords: COMORBIDITY; HUMAN IMMUNODEFICIENCY VIRUS; RHEUMATOID ARTHRITIS