Avascular necrosis and protease inhibitors

Area of Science:

• Infectious Diseases
• Orthopedics
• Bone Metabolism

Background:

• Avascular necrosis (AVN) is characterized by ischemic bone death due to compromised arterial blood supply.
• HIV-infected patients exhibit a higher incidence rate of AVN compared to the general population.
• While highly active antiretroviral therapy (HAART) is implicated, AVN predates HAART, suggesting multifactorial etiology.

Observation:

• Three case reports of AVN in patients from an infectious disease clinic are presented.
• No prior cases of AVN were documented in the clinic's patient population before this report.
• Affected sites in the observed AVN cases included the hip and shoulders.

Findings:

• The incidence of AVN within the studied HIV-infected patient population exceeded that of the general population.
• The increased longevity of HIV patients due to HAART leads to prolonged exposure to antiretroviral (ARV) therapy.
• Treatment-related complications, such as AVN, may become more evident with extended ARV therapy in HIV patients.

Implications:

• Clinicians managing HIV-infected patients require heightened awareness of AVN as a potential complication.
• Early recognition and management of AVN are crucial for preserving bone health in HIV patients on HAART.
• Further research is warranted to elucidate the precise mechanisms linking HAART and AVN development.