To report the rate and spectrum of the rheumatic manifestations of human immunodeficiency virus (HIV) since the advent of highly active anti-retroviral therapy (HAART). A retrospective record review of 888 inpatients with HIV for rheumatic manifestations was performed from January 1995 to March 2006. We then searched the 888 records for rheumatic diseases using International Classification Diagnostic (ICD) Codes. The medical records of the cases of HIV with the rheumatic conditions were then reviewed. A computer-assisted search of Medline/Pubmed for the medical literature from January 1981 to August 2007 using the keywords HIV, acquired immune-deficiency syndrome, rheumatic manifestations, combining with text words like systemic lupus erythematosus (SLE). Only English language literature was included. The demographic data of 888 cases of HIV included men (64%) and women (36%) with a mean age of 41.5+/-10.2 years. Race consisted of Black (70%), White (22.8%), Hispanic (6.5%), and others (1.1%). Rheumatic manifestations were present in 80 (9%) with arthritis/arthralgia 49 (5.5%), septic arthritis 9 (1%), and osteomyelitis 8 (0.9%), connective tissue diseases (CTDs) 6 (0.7%) (SLE 3, rheumatoid arthritis 1, polymyositis 1, and systemic sclerosis 1), avascular necrosis 6 (0.7%) (hips 3, knees 2, and shoulder 1). There were no cases of seronegative spondyloarthritis or Sjögren's syndrome. There was an association of HIV with rheumatic conditions in 9%, including CTDs and avascular necrosis. In addition, there were no cases of the seronegative spondyloarthritis subsets. This change in spectrum from prior reports suggests the rheumatic manifestations of HIV have changed, perhaps related to HAART.