Etiological Diagnosis of Infectious Coxitis Depending on the Patient's HIV Status

The objective: to develop the procedure for etiological diagnosis of infectious coxitis (IC) depending on the patient's HIV status.

Subjects and Methods. The data of medical records of 97 patients with signs of IC were analyzed. Patients were divided into group depending on their HIV status.

Results. The time required to diagnose IC was identified, and it made 7.35 ± 1.30 months for HIV-positive patients, and 6.25 ± 0.90 months for HIV negative patients (p > 0.05). The procedure was developed to be implemented when a patient complained of pain in the hip joint. Patients with HIV infection and suspected IC should undergo computed tomography (CT) of the hip joints, and HIV-negative patients should have CT done if the hip joint X-ray is not informative. The use of CT in the HIV+ Group reduced the diagnostic time from 9.4 ± 1.3 to 5.3 ± 1.3 months (p = 0.680), in the HIV- Group – from 8.7 ± 1.2 to 3.8 ± 0.6 months (p = 0.02). The reason why diagnosis took that long was the rare use of invasive methods at the outpatient stage. Thus, puncture of the hip joint was performed in the HIV+ Group in 2.7% of cases, in the HIV- Group – in 10%. Trepanobiopsy performed in a hospital made it possible to establish the etiology of IC in all patients. The diagnostic efficacy of microbiological tests in case of tuberculous coxitis made 48.64% in the HIV+ Group and 30.0% in the HIV- Group, in case of nonspecific coxitis it was 32.43% and 30.0%, respectively.

1. S. Glantz. Mediko-Biologicheskaya Statistika. (Russ. Ed.: Stanton A. Glantz. Primer of biostatistics). Moscow, Praktika Publ., 1998, 459 p.

2. Klinicheskie rekomendatsii VICH-infektsiya u vzroslykh 2020. [Guidelines, HIV infection in adults, 2020]. https://cr.minzdrav.gov.ru/schema/79_1.

3. Klinicheskie rekomendatsii po diagnostike i lecheniyu tuberkuleza kostey i sustavov u vzroslykh. [Guidelines for diagnostics and treatment of bone and joint tuberculosis in adults]. Developed by: M.S. Serdobintsev (Chairman), A.I. Berdes, S.V. Burlakov, A.A. Vishnevskiy, N.R. Irisova, A.S. Kaftyrev, Z.Kh. Kornilova, A.Yu. Mushkin, M.V. Pavlova, E.O. Peretsmanas, O.A. Trushina, D.L. Khaschin. Medalyans Publ., 2014, no. 4, no. 3, 2014.

4. Mamaeva L.A., Skornyakov S.N., Podgaeva V.A., Klimov M.E., Dotsenko I.A. Using etiological techniques for diagnostics of spondylitis of various etiology. Tuberculosis and Lung Diseases, 2015, no. 6, pp. 94-95. (In Russ.)

5. Panteleev A.M. Patogenez, klinika, diagnostika i lechenie tuberkuleza u bolnykh VICH- infektsiey. Diss. dokt. med. nauk. [Pathogenesis, symptoms, diagnostics and treatment of tuberculosis in HIV patients. Doct. Diss.]. St. Petersburg, 2012, 214 p.

6. Reshetneva E.V. Tuberkulezniy spondilit u bolnykh VICH-infektsiyey i effektivnost yego khirurgicheskogo lecheniya: Dis. kand. med. nauk. [Tuberculous spondylitis in HIV positive patients and efficacy of its surgical treatment. Cand. Diss.]. 2015.

7. Biviji A.A., Paiement G.D., Steinbach L.S. Musculoskeletal Manifestations of Human Immunodeficiency Virus Infection. J. Am. Acad. Orthop. Surg., 2002, vol. 10, issue 5, pp. 312.

8. Charalampos G.Z., Dellamaggiora R., Patzakis M.J., Bava E., Holtom P.D. Septic arthritis in patients with human immunodeficiency virus. Clin. Orthop. Relat. Res., 2006, no. 451, pp. 46-49. doi:10.1097/01.blo.0000229305.97888.17.

9. Khan M.K., Islam M.N., Ferdous J., Alam M.M. An Overview on epidemiology of tuberculosis. Mymensingh Med. J., 2019, vol. 28, no. 1, pp. 259-266. PMID: 30755580.

10. Leitao J., Martin L., Desclaux A., Dutronc H., Neau D., Dauchy F.A. Experience of ultrasound performed by infectiologists, an innovating approach for the management of patients. Infect. Dis. Now., 2021, vol. 51, no. 5, pp. 451-455. doi: 10.1016/j.idnow.2020.10.008. Epub 2020 Dec 30. PMID: 34366081.

11. Lum Z.C., Shieh A.K., Meehan J.P. Native adult hip with bacterial septic arthritis. J. Bone Joint Surg. Rev., 2018, vol. 6, no. 10, pp. e2. https://doi.org/10.2106/JBJS.RVW.17.00211.

12. Mehsen-Cêtre N., Cazanave C. Osteoarticular manifestations associated with HIV infection. Joint Bone Spine, 2017, vol. 84, no. 1, pp. 29-33. doi: 10.1016/j.jbspin.2016.04.004. Epub 2016 May 26. PMID: 27238195.

13. Ntsiba Н., Makosso E., Ngandeu-Singwé M., Yala F. Septic arthritis in tropical environment. 176 cases report in Brazzaville. Mali Med., 2006, vol. 21, no. 1, pp. 49-53.

14. Raynaud-Messina Brigitte et al. Bone degradation machinery of osteoclasts: An HIV-1 target that contributes to bone loss. Proceedings of the National Academy of Sciences of the United States of America, 2018, vol. 115, no. 11, pp. E2556-E2565. doi:10.1073/pnas.1713370115.

15. Ross J.J. Septic arthritis of native joints. Infect.Dis.Clin.North Am., 2017, vol. 31, no. 2, pp. 203-218. doi: 10.1016/j.idc.2017.01.001. Epub 2017 Mar 30.

16. Tornero E., Garcia S., Larrousse M., Gallart X., Bori G., Riba J. et al. Total hip arthroplasty in HIV-infected patients: a retrospective, controlled study. HIV Med., 2012, vol. 13, no. 10, pp. 623-629.

17. WHO case definition of HIV for surveillance and revised clinical staging and immunological classification of HIV-related disease in adults and children. 2007. http://www.who.int/hiv/pub/guidelines/HIVstaging150307.

18. Yongseop L. , Yun S.C., Yu J.S., Jong H.H., Sang M.A., Woon J.L., Jung H.K., Hye S., Junhyoung K., Su J.J., Nam S.K., Joon S.Y., Jin Y.A., Jun Y.C. Clinical characteristics and causative pathogens of infective arthritis and risk factors for gram-negative bacterial infections. Infect. Chemother., 2020, vol. 52, no. 4, pp. 503-515. doi: 10.3947/ic.2020.52.4.503.