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Osteonecrosis in HIV: a case-control study.

A N Scribner1, P V Troia-Cancio, B A Cox

  • 1The University of Texas Southwestern Medical Center, Dallas, TX 75390-9113, USA.

Journal of Acquired Immune Deficiency Syndromes (1999)
|November 7, 2000
PubMed
Summary
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Osteonecrosis is more common in HIV patients due to risk factors like hyperlipidemia and alcohol use. While some medications showed associations, protease inhibitors were not independently linked to this condition in HIV patients.

Area of Science:

  • Infectious Diseases
  • Orthopedics
  • Virology

Background:

  • Osteonecrosis (avascular necrosis) is infrequently reported in Human Immunodeficiency Virus (HIV)-infected patients.
  • The independent contribution of HIV infection to osteonecrosis risk remains unclear.

Purpose of the Study:

  • To investigate potential risk factors for osteonecrosis in HIV-infected patients.
  • To determine if HIV itself is an independent risk factor for osteonecrosis.

Main Methods:

  • Retrospective chart review of 25 osteonecrosis cases in HIV patients from 1984-1999.
  • Matched each case with two controls based on HIV status and diagnosis date.
  • Evaluated various potential risk factors including hyperlipidemia, alcoholism, and medication use.

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Main Results:

  • 88% of osteonecrosis cases had at least one risk factor, compared to 48% of controls (p=.003).
  • Common risk factors included hyperlipidemia (32%), alcoholism (28%), and pancreatitis (16%).
  • Saquinavir was independently associated with osteonecrosis (p<.05), but protease inhibitors overall were not.

Conclusions:

  • Increased osteonecrosis in HIV/AIDS patients may stem from a higher prevalence of known risk factors.
  • Hyperlipidemia, corticosteroid use, alcohol abuse, and hypercoagulability are significant risk factors.
  • Protease inhibitor use was not found to be an independent risk factor for osteonecrosis in this cohort.