title: Arthritis in childhood human immunodeficiency virus infection predominantly associated with human leukocyte antigen B27.
abstract: OBJECTIVE
  Children with human immunodeficiency virus (HIV) infection usually present with recurrent and unusual infections. Although reported among adults, arthritis as a predominant presentation in children with HIV is rare. Reactive arthritis is considered to be the most common musculoskeletal manifestation in adults with HIV infection. However, in children, septic or HIV-related arthritis has been described. We report four children having arthritis with HIV disease and their long-term outcome; out of which three had human leukocyte antigen (HLA)-B27-related arthritis. It is important to be aware of arthritic presentation of HIV disease in children to prevent delay in diagnosis and initiation of appropriate therapy.
  
  
  METHODS
  Clinical profile of children with HIV infection who presented with arthritis and registered at the Pediatric Immunodeficiency Clinic at PGIMER, Chandigarh were reviewed and analyzed.
  
  
  RESULTS
  A total of 796 children with HIV infection are registered in the Pediatric Immunodeficiency Clinic since January 1994. Among these, four children had arthritis, and it was the presenting manifestation in two of them. HLA-B27 related arthritis was noted in three children, while one had HIV-associated arthritis. None of the children had septic arthritis. Arthritis resolved on treatment with antiretroviral therapy (ART) in two children, while others responded to anti-inflammatory agents and the joint symptoms remained quiescent on follow-up with a total follow-up period of 21.5 patient years.
  
  
  CONCLUSIONS
  Clinicians must be aware of the arthritic presentation of childhood HIV infection. High degree of suspicion must be entertained to screen for HIV infection in children with arthritis, especially in those with reactive arthritis.
authors.affiliation: Allergy-Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India. surideepti@gmail.com.
authors.forename: Deepti
authors.initials: D
authors.lastname: Suri
authors.affiliation: Allergy-Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
authors.forename: Avinash
authors.identifier: http://orcid.org/0000-0003-4433-4355
authors.initials: A
authors.lastname: Sharma
authors.affiliation: Allergy-Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
authors.forename: Sagar
authors.initials: S
authors.lastname: Bhattad
authors.affiliation: Allergy-Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
authors.forename: Amit
authors.initials: A
authors.lastname: Rawat
authors.affiliation: Department of Immuno-Pathology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
authors.forename: Sunil
authors.initials: S
authors.lastname: Arora
authors.affiliation: Department of Immuno-Pathology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
authors.forename: Ranjana W
authors.initials: RW
authors.lastname: Minz
authors.affiliation: Allergy-Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
authors.forename: Surjit
authors.initials: S
authors.lastname: Singh
mesh_terms: D000367:Age Factors; D017668:Age of Onset; D019380:Anti-HIV Agents / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D016918:Arthritis, Reactive / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology*; D002648:Child; D002675:Child, Preschool; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology* / Q000821:virology; D015796:HLA-B27 Antigen / Q000276:immunology*; D006801:Humans; D007194:India; D008297:Male; D012042:Registries; D012074:Remission Induction; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D019380:Anti-HIV Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D015796:HLA-B27 Antigen
keywords: ART; HLA-B27; reactive arthritis; rheumatological