Orthopedic Illnesses in Patients with HIV Sukhjit S. Takhar, MD a,b, *, Gregory W. Hendey, MD a HIV infection and the medications used to treat it can cause a wide range of muscu- loskeletal problems. 1 Patients infected with HIV are susceptible to most of the same types of fractures, dislocations, and other musculoskeletal disorders as patients without HIV. However, there are several musculoskeletal conditions that are specific or unique to the patient infected with HIV. The advent of antiretroviral therapy (ART) has changed the course of the disease. AIDS was transformed from an invariably fatal condition to a chronic manageable disease in developed countries. 2,3 This disease shift was accompanied by a corre- sponding change in the types of musculoskeletal complications that patients infected with HIV may experience. For example, there has been a decrease in opportunistic infections of the bone, and an increase in osteopenia and osteonecrosis. 4,5 HIV, the immune response, and medications can be directly toxic to the bones, joints, and muscles. The cellular immune system is compromised and unusual organ- isms and malignancies can affect the host. Infections tend to present at a more advanced stage because of the underlying immune status of the patients. Certain rheumatologic conditions such as reactive arthritis (formerly Reiter syndrome) also seem to be more common in this patient population. The specific musculoskeletal conditions affecting the patient infected with HIV may be divided into 4 categories: disseminated diseases, bone disorders, joint disease, and myopathies. DISSEMINATED DISEASES Neoplastic Immunosuppression predisposes patients to malignancy. Kaposi sarcoma (KS) and high-grade non-Hodgkin lymphoma (NHL) are prototypical AIDS-defining malignant diseases. A conservative estimate suggested that AIDS increases the risk of KS by a UCSF-Fresno Emergency Medicine Residency Program, UCSF, 155 North Fresno Street, Fresno, CA 93701-2302, USA b Division of Infectious Disease, UCSF-Fresno, Fresno, CA, USA * Corresponding author. UCSF-Fresno Emergency Medicine Residency Program, UCSF, 155 North Fresno Street, Fresno, CA 93701-2302. E-mail address: stakhar@fresno.ucsf.edu KEYWORDS  HIV infection  Musculoskeletal disorder  Orthopedic illnesses Emerg Med Clin N Am 28 (2010) 335–342 doi:10.1016/j.emc.2010.01.009 emed.theclinics.com 0733-8627/10/$ – see front matter ª 2010 Elsevier Inc. All rights reserved.