Acute arthritis and human immunodeficiency virus infection in Rwanda

To determine the etiology of acute arthritis observed in adults and to define its relationship with human immunodeficiency virus 1 (HIV-1) infection in Kigali, capital city of Rwanda.From September 1, 1989 until March 31, 1990 we conducted a study of all new patients admitted with acute arthritis to the outpatient and inpatient services of the Department of Internal Medicine at the Centre Hospitalier de Kigali, in Kigali, Rwanda, a city highly endemic for HIV infection.Thirty-six patients (27 men 9 women; mean age: 31 years, range 18-65) were included in the study. Twenty-six (72%) were HIV seropositive. Two main diagnostic categories emerged, both strongly associated with HIV infection: (1) aseptic arthritis: 16 (44.5%) patients including 12 (33.5%) patients with spondyloarthropathy of whom 10 (83%) were HIV seropositive, and 4 (11%) patients with HIV related arthritis, (2) septic arthritis: 11 (30%) patients of whom 9 (82%) were HIV seropositive, including 4 with gonococcal, 2 with staphylococcal, 1 with Salmonella B and 2 with tuberculous arthritis.In an area highly endemic for HIV, acute arthritis should be considered a possible manifestation of HIV infection and should prompt HIV testing.HIV infection is highly endemic in Kigali, Rwanda. The authors report findings from a study conducted from September 1, 1989 to March 31, 1990, to determine the etiology of acute arthritis observed in adults and its relationship with HIV-1 infection in the city. Careful medical histories and full clinical evaluations were conducted upon each new patient admitted with acute arthritis to the outpatient and inpatient services of the Department of Internal Medicine at the Centre Hospitalier de Kigali over the period. 27 men and 9 women of mean age 31 years in a range of 18-65 years presented, of whom 72% were HIV seropositive. Aseptic arthritis was diagnosed in 16 patients of whom 14 were HIV seropositive. 12 patients fulfilled the criteria of spondylarthropathy of whom 10 were HIV seropositive. There were 4 cases of HIV-related polyarthritis, while septic arthritis was identified in 11 patients of whom 9 were HIV seropositive, including 4 with gonococcal, 2 with staphylococcal, 1 with Salmonella B, and 2 with tuberculosis arthritis. The authors stress on the basis of these findings the need in an area highly endemic for HIV to consider acute arthritis a possible manifestation of HIV infection which necessitates the testing for HIV.