(1) Emory University School of Medicine, Atlanta, Georgia, United States
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The vast progress in management of HIV disease with anti-retroviral therapy (ART) in the past three decades has resulted in increased life expectancy for people living with HIV/AIDS. With this new chronicity of the disease has emerged a constellation of musculoskeletal impairments ranging from arthritis to traumatic fractures requiring orthopedic surgery. This manuscript aims to review and critique recent research (2009-2014) investigating musculoskeletal complications of HIV disease, and to propose future directions for management of such diagnoses.
The literature reviewed was divided into the following categories, in order of publication date: general musculoskeletal complications arising from the HIV virus itself and/or ART, HIV-related bone infections and bone disease, rheumatic disease in HIV infection, vitamin D deficiency in HIV disease, and orthopedic post-surgical complications/risk factors resulting from HIV disease.
A total of 19 articles met the described inclusion criteria and were included in this critical review. From most recent (2014) to oldest (2009), 4 articles were published in 2014, 7 in 2013, 3 in 2012, 1 in 2011, 2 in 2010 and 2 in 2009.
While the pathophysiology of HIV-related musculoskeletal complications is well documented in the literature, it is crucial that attention is also focused on treatment. The complex nature of disability in PLWHA necessitates a multidisciplinary approach to treatment to adequately address the diagnostic and treatment needs of this population.
Given the multitude of musculoskeletal complications that arise from the HIV virus and/or ART, research must be continuously conducted to assess risk, prevention and treatment. This research will need to focus on both non-surgical and surgical approaches to management of musculoskeletal complications in the HIV-infected individual.