The clinical features of an acute arthritis in 20 Zimbabwean patients, 17 of whom fulfilled criteria for the diagnosis of complete or incomplete Reiter's syndrome, are described. Fourteen of 19 patients tested were positive for human immunodeficiency virus (HIV) antibodies and most had features of the AIDS related complex. None of 14 patients tested possessed the HLA-B27 tissue antigen commonly associated with Reiter's syndrome. The relationship between HIV infection, immunogenetic factors and the arthropathy we have observed remains to be elucidated.
PIP: A review of the cases of 20 Zimbabwean patients with acute arthritis raises the possibility of an association between arthropathy, immunogenetic factors, and human immunodeficiency virus (HIV) infection. The 19 men and 1 woman included in the analysis ranged in age from 23-41 years and had been referred to the University of Zimbabwe's rheumatic diseases clinic over a 6-month period with seronegative acute arthritis. In each case, there had been an acute onset of the arthropathy with painful swelling of 1 or more peripheral joints, generally the knee and ankle. 17 patients met the clinical criteria for Reiter's syndrome--an extremely uncommon condition in souther Africa--yet none exhibited the tissue antigen, HLA-B27 that is characteristic of this syndrome and reactive arthritis. Of note was the finding that, of the 19 patients screened, 14 (74%) showed antibodies to HIV and 11 exhibited some features of acquired immunodeficiency syndrome (AIDS)-related complex, especially weight loss, fever, and generalized lymphadenopathy. No HIV- positive patient was a homosexual, intravenous drug abuser, or blood transfusion recipient. Since the 74% prevalence of HIV antibodies in this series exceeds that found even in high-risk populations (e.g., 18% among patients attending sexually transmitted disease clinics in Harare), it seems unlikely to be a chance finding. Rather, the possibility exists that the arthropathy in this series of patients is HIV-related and may be an as yet unidentified clinical feature of HIV infection.