Avascular Necrosis in HIV-Infected Patients Receiving Antiretroviral Treatment: Study of Seven Cases

Valencia, Eulalia; Barreiro, Pablo; Soriano, Vincent; Blanco, Francisco J.; Lahoz, J. González

doi:10.1310/8ew3-gyj9-08na-6d5h

Cited by 17 publications

(16 citation statements)

References 17 publications

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“…This is a narrower range than the previously stated estimate of the HIV1 population having a 3 to 100 times greater risk of developing ON. [3][4][5][6][7] One notable challenge in managing ON in the HIV1 populations is the earlier age of onset compared with the general population. 4,6,20,23 HIV1 patients tend to present ON symptoms in their fourth decade of life, with the time to diagnose ON after HIV diagnosis ranging from 4.4 to 13.5 years.…”

Section: Discussionmentioning

confidence: 99%

“…This could confound the results because there appears to be a time-dependent relationship between time since HIV diagnosis (average of 12.9 years from HIV diagnosis to ON) and initiation of ART (risk of ON with treatment with TDF > 1 year [OR, 4.4; 95% CI, 1.4 to 14]) with the incidence of ON. 4,6,7,19 In addition, regarding time, it is possible that patients had a diagnosis of ON before HIV or taking ART that was unable to be captured in the database, potentially skewing our results. Other limitations of the study are related to the utilization of administrative claims databases.…”

Section: Limitationsmentioning

confidence: 99%

“…19 However, when mutually adjusting for other variables, many single-center studies cannot associate HIV, ART, and ON because of the rarity of ON and the small sample sizes. 3,4,7,19,25–30…”

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confidence: 99%

“…[10][11][12] This leads to poor functional outcomes, such as pain and eventual collapse of the affected joint surface. 4,7,[13][14][15][16][17] Periarticular ON is most prevalent in the hip, but it can affect other joints, including the knee or shoulder. 3,7,18 Risk factors for ON include corticosteroid use, 4,7,19 alcohol abuse, 4,7,14,[19][20][21] hyperlipidemia, 4,7,19,22 race, 18,22 body mass index, 20 prior ON, 22 socioeconomic status, 20 sex, 20,23 trauma, 20 sickle cell disease, 7,24 smoking, 7 intravenous drug use, 22 and age.…”

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confidence: 99%

“…18 HIV is also a known risk factor for ON, with early literature suggesting that ART may be an additional, independent risk factor. 3,4,7,19,25,26 When analyzed individually, protease inhibitors 4,7,26 specifically didanosine, indinavir, saquinavir, lopinavir, and tenofovir (TDF) are associated with ON in the HIV positive (HIV1) population. 19 However, when mutually adjusting for other variables, many singlecenter studies cannot associate HIV, ART, and ON because of the rarity of ON and the small sample sizes.…”

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confidence: 99%

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Antiretroviral Therapy and Periarticular Osteonecrosis Development in Patients With HIV

Bahoravitch

Agarwal

Ifarraguerri

et al. 2022

J Am Acad Orthop Surg

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Introduction: With modern antiretroviral therapy (ART), HIV has become a chronic condition. Previous studies have not definitively assessed the risk of periarticular osteonecrosis (ON) that ART poses to the HIV population. Methods: A retrospective case-control study using the PearlDiver database was done using International Classification of Diseases codes. Patients were selected from 2010 to 2019 with a diagnosis of periarticular ON and HIV taking ART (HIV1/ART1) and not taking ART (HIV1/ART2). The control was patients HIV2 and not on ART. Subcategorization, by International Classification of Diseases codes, was used for which joint was affected-hip, knee, or shoulder-excluding patients with ON of the jaw. Chi-squared univariate analysis was used to compare incidence rates and control for age, sex, Elixhauser comorbidities, and other known risk factors for developing ON in multivariable analysis. Results: In total, 219,853 patients had HIV between 2010 and 2019. Of those patients, 123,710 (56.27%) had a history of ART (HIV1/ART1), while 96,143 (43.74%) did not (HIV1/ART2). Difference in incidence rates for HIV1/ART1 was higher in any joint (11.7%), as well as the hip (11.31%), knee (10.08%), and shoulder (10.08%). All risk factors met inclusion criteria in the multivariate analysis except coagulopathy. Multivariate analysis found that patients in the HIV1/ART1 cohort had higher odds of developing periarticular ON when compared with the HIV1/ART2 cohort in any joint (odds ratios = 1.40; 95% CI, 1.38 to 1.42), hip (OR:1.41; 95% CI, 1.38-1.43), knee (OR:2.56; 95% CI, 2.39 to 2.74), and shoulder (OR:1.05; 95% CI, 1.01-1.10). Conclusion: Patients with HIV taking ART have well-established morbidity and mortality benefits. However, this study found that ART is associated with a higher risk of developing periarticular ON when compared with those not taking ART. Therefore, clinicians should be

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Section: Discussionmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Antiretroviral Therapy and Periarticular Osteonecrosis Development in Patients With HIV

Bahoravitch

Agarwal

Ifarraguerri

et al. 2022

J Am Acad Orthop Surg

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Current awareness: Pharmacoepidemiology and drug safety

2004

Pharmacoepidemiology and Drug

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Stuck on Ru: The lability of the N2 ligand is thought to limit the efficacy of late‐transition‐metal complexes for the catalytic activation of N2. However, complex 1 is found to bind N2 with unprecedented strength. This species resists displacement of N2 by CO at room temperature, while computational and experimental data suggest that the Ru–N2 binding is stronger than the Ru–IMes binding. IMes=N,N′‐bis(mesityl)imidazol‐2‐ylidene.

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HIV Therapy—The State of ART

Looney

Johns

2015

The Future of HIV-1 Therapeutics

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HIV Attachment. In this cross section, HIV is shown at the top and a target cell is shown at the bottom in blues. HIV envelope protein (A) has bound to the receptor CD4 (B) and then to coreceptor CCR5 (C), causing a change in conformation that inserts fusion peptides into the cellular membrane Antiretroviral therapy changed the face of HIV/AIDS from that of soon and certain death to that of a chronic disease in the years following introduction of highly active antiretroviral therapy in 1995-1996 (initially termed HAART, but now most often abbreviated to ART since not all combinations of regimens are equally active). Since then, many new agents have been developed and introduced in response to problems of resistance, toxicity, and tolerability, and great advances have been achieved in accessibility of HIV drugs in resource-poor global regions. Potential challenges that providers of HIV therapy will face in the coming decade include continuing problems with resistance, especially where access to drugs is inconsistent, determining how best to combine new and existing agents, defining the role of preventive treatment (pre-exposure prophylaxis or PrEP), and evaluating the potential of strategies for cure in some populations.

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Avascular Necrosis in HIV-Infected Patients Receiving Antiretroviral Treatment: Study of Seven Cases

Abstract: Metabolic and bone diseases should be considered a complication of HIV infection that is of growing importance.

Cited by 17 publications

References 17 publications

Antiretroviral Therapy and Periarticular Osteonecrosis Development in Patients With HIV

Antiretroviral Therapy and Periarticular Osteonecrosis Development in Patients With HIV

Current awareness: Pharmacoepidemiology and drug safety

HIV Therapy—The State of ART

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