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Arthritis in HIV
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    I read with great interest the clinical brief "Arthritis in HIV" by Ahuja et al[1] and I have two points to raise: ( 1 ) The child in the given case had a clinical history consistent with rheumatic arthritis (swelling of large joints off and on, though it was not mentioned whether it was migratory in nature, which was tender, markedly erythematous, restricting the movements and reasonably good response to anti-inflammatory agents).[2] ESR was also suggested. Even then, no comment has been made about the status of heart, nor any investigation was done to look for rheumatic activity (ASO titres, ECG etc.) (2) Since the child has been diagnosed as a case of HIV, suggestive by past history of herpes zoster, mild oral candidiasis, positive ELISA and western blot, a CD4 T-Cell count was compulsory to decide the therapy, prognosticate and monitor the progress of treatment.[3],[4] Instead of doing VDRL, rheumatoid factor, anti-nuclear antibody and double-stranded DNA, which seems futile tests in this case (Nothing to suggest Syphilis, rheumatoid arthritis and SLE), a CD4 cell count would have been much useful and necessary investigation, specially looking at the gravity of the disease.

    References

    1. Ahuja AR, Oak J, Sawant S, Kulkarni MV. Arthritis in HIV. Indian J Pediatr 2003; 70: 835-836

    2. Todd JK. Rheumatic Fever. In Behrman RE, Kliegmann RM, Jenson HB, eds. Nelsons Textbook of Pediatrics. 16th edn. Philadelphia WB Saunders Company; 2000; 806-810.

    3. Mills GD, Jones PL. Relationship between CD4 Lymphocyte counts and AIDS mortality (1986-1991). AIDS 1993; 7: 1383-1386

    4. Colford JM, Ngo L, Tager I. Factors associated with survival in human immunodeficiency virus with very low CD4 counts. Am J Epidemiol 1994; 139: 206-218.(Garg Pankaj)