Avascular necrosis and protease inhibitors

Avascular necrosis (AVN) indicates ischemic death of the bone due to insufficient arterial blood supply. The incidence rate of AVN is higher in HIV-infected patients than in the general population. Although the exact etiology of AVN remains unclear, the literature has shown a relationship between AVN and exposure to highly active antiretroviral therapy (HAART). It should be noted, however, that AVN has been reported before the era of HAART, thus suggesting the involvement of other causative factors as well. Three case reports based on patients attending the infectious disease clinic are presented. No cases of AVN are reported in our clinic population prior to this report. Affected sites of AVN included the hip and shoulders. The incidence of AVN within our patient population was higher than the general population. Although the introduction of HAART has improved patient longevity, it has also led to longer exposure to antiretroviral (ARV) therapy. Thus, it is likely that treatment-related complications may become more apparent in the HIV-infected population. This may be the case with AVN. Therefore, clinicians need to be alert to the potential complication of AVN in HIV-infected patients treated with HAART.