174 Volume 23, Number 2, 2009 Temporomandibular Joint Disorders During HIV Infection: A Case Report T emporomandibular disorders (TMD) is a term reflecting clinical conditions usually of unclear etiology encompassing an array of signs and symptoms related to the temporo- mandibular joint (TMJ) or the masticatory muscles. 1,2 Patients infected with human immunodeficiency virus (HIV) frequently complain of musculoskeletal pain such as myalgia, arthralgia, and arthritis, as well as neuropathic chronic pain. 3,4,5 In addition, the intake of protease inhibitors used to manage the HIV infection may elicit pain and joint pathology. 3,6,7 This report describes the case of an HIV-infected adult patient complaining of TMD during active antiretroviral treatment. Case Report A 36-year-old HIV-positive male was referred to the Orthodontic/ TMD department because of bilateral persistent pain in the TMJ region and chewing impairment lasting about 15 months. The patient reported a 2-year history of intake of protease inhibitors (lopinavir, 400mg/daily) and nucleoside reverse transcriptase (NRT) inhibitors (tenofovir, 300mg/daily) to control the HIV infec- tion. The TMJ pain, that had started about 8 to 9 months after ini- tiation of the HIV therapy, was very intense and reached a value of 10 on a visual analog scale (VAS) where 0 indicated “no pain” and 10 “the most severe pain possible.” The use of analgesics had been Paolo M. Fiorentino, DMD, MS, PhD Former Fellow Division of Orthodontics/TMJD University of Rochester Rochester, New York and Adjunct Professor Department of Orthodontics/TMD Faculty of Medicine and Surgery University of Turin Turin, Italy Maria G. Piancino, MD, DMD, PhD Internal Fellow and Adjunct Professor Cesare Debernardi, MD, DMD Full Professor Department of Orthodontics/TMD Faculty of Medicine and Surgery University of Turin Turin, Italy Nikolai Attard, DDS, MS, PhD Assistant Dean Faculty of Dentistry University of Malta Correspondence to: Dr P.M. Fiorentino 520 Elmwood Street Eastman Dental Center University of Rochester Rochester, NY 14620 Email: paolo05@yahoo.com Temporomandibular disorders (TMD) is a term reflecting chronic, painful, craniofacial conditions usually of unclear etiology with impaired jaw function. Human immunodeficiency virus (HIV)- infected patients often report chronic pain and pathologies target- ing body joints during retroviral therapy. Although both condi- tions may share similar secondary disorders, no conclusive cause-effect relationship has been found linking the TMD to the HIV-antiviral treatment. This report describes a case of TMD associated with HIV infection during active retroviral therapy. Clinicians should be aware that treatment of an HIV-infected patient with TMD requires an interdisciplinary team approach. J OROFAC PAIN 2009;23:174–176 Key words: human immunodeficiency virus, infection, pain, retroviral therapy, temporomandibular disorders, temporomandibular joint COPYRIGHT © 2008 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY. NO PART OF THIS ARTICLE MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER