When it is suspected that Reactive Arthritis may be a complication of HIV infection?
ReA is seen in HIV patients but is generally believed to be related to other infections to which patients have been exposed, rather than to HIV itself. An association between ReA and HLA-B27 has been noted in Caucasian HIV-infected patients, but not in patients from sub-Saharan Africa where the prevalence of HLA-B27 is much lower and ReA was rare before the HIV epidemic. This finding suggests a “trigger” role of the HIV in the latter population. Given the uncertainty, HIV antibody status should be determined when the appropriate risk factors and/or clinical features are present. Patients with refractory ReA and risk factors for HIV should also have testing prior to the use of immunosuppression.