Avascular necrosis in HIV infection

Johns, Daniel; Gill, M. John

doi:10.1097/00002030-199910010-00036

Cited by 25 publications

(8 citation statements)

References 6 publications

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“…Over the past decade, multiple case reports have suggested an association between human immunodeficiency virus (HIV) infection and osteonecrosis [2][3][4][5][6][7]. Some of the case patients described have had risk factors that exist for persons not infected with HIV, such as hyperlipidemia [3,4], alcoholism [2], and corticosteroid use [2].…”

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confidence: 99%

“…Some of the case patients described have had risk factors that exist for persons not infected with HIV, such as hyperlipidemia [3,4], alcoholism [2], and corticosteroid use [2]. Other described patients have had no recognized risk factors [7], suggesting that HIV infection, its therapy, and/or associated comorbidities may be predisposing factors.…”

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confidence: 99%

“…Recent reports suggest that the incidence of osteonecrosis among HIV-infected patients may be increasing [4,[7][8][9]; however, it is unclear whether this increase is due to greater recognition of the entity, prolonged patient survival owing to potent antiretroviral therapy, or direct or indirect adverse effects of newer antiretroviral agents. To further evaluate potential risk factors for HIV-associated osteonecrosis, including protease inhibitor therapy, we conducted a case-control study, using data from an urban HIV clinic.…”

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confidence: 99%

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Osteonecrosis in Patients Infected with Human Immunodeficiency Virus: A Case‐Control Study

2001

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To evaluate risk factors for osteonecrosis in human immunodeficiency virus (HIV)-infected patients, demographic and clinical characteristics of case patients (n=17) and control patients (n=34) matched on initial clinic visit date, length of follow-up, and baseline CD4 cell count were compared. Case patients were more likely to have received corticosteroids (47.1% vs. 8.8%; matched odds ratio [OR], 13.1; 95% confidence interval [CI], 1.6-106), to have had an increase in CD4 cell count from nadir >0.050 x 10(9) cells/L (64.7% vs. 35.3%; OR, 4.9; 95% CI, 1.0-24), and to have had Pneumocystis carinii pneumonia (52.9% vs. 11.8%; OR, 7.6; 95% CI, 1.6-36). Use of protease inhibitors and history of other opportunistic infections did not significantly differ. In multivariate analysis, use of corticosteroids remained significantly associated with osteonecrosis, independently of HIV disease stage and protease inhibitor therapy. Corticosteroid use is an important risk factor for osteonecrosis, but its pathogenesis is likely multifactorial.

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Osteonecrosis in Patients Infected with Human Immunodeficiency Virus: A Case‐Control Study

2001

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“…Over the past decade, there have been many case reports of avascular necrosis of bone (AVN) occurring in persons with underlying HIV infection [1][2][3][4][5][6][7][8][9][10][11][12]. Most of these patients appear to have no known predisposing factor for AVN, and it has been suggested that HIV infection itself may be a risk factor for osteonecrosis.…”

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Avascular Necrosis of Bone in Patients with Human Immunodeficiency Virus Infection: Report of 6 Cases and Review of the Literature

Brown

Crane

2001

Clinical Infectious Diseases

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In 1998 and 1999, we diagnosed avascular necrosis of bone in 6 patients in our human immunodeficiency virus clinic practice, an incidence of 0.45%, which is 45 times greater than would be expected in the general population. Antiphospholipid antibodies and hyperlipidemia secondary to protease inhibitor therapy have been implicated as possible etiologies; however, these abnormalities cannot explain all cases of avascular necrosis of bone reported in patients with human immunodeficiency virus infection.

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“…It has been suggested that osteonecrosis in this population may be caused by an increased prevalence of risk factors, including the use of corticosteroids and megestrol acetate, hypertriglyceridemia, ethanol abuse, local trauma and hypercoagulable states (3,4). The relation between osteonecrosis and the use of protease inhibitors (PI) has been challenged because cases of osteonecrosis were reported before the availability of this group of antiretroviral drugs and even in patients without any treatment (5).…”

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confidence: 99%

Osteonecrosis in patients with acquired immunodeficiency syndrome (AIDS): report of two cases and review of the literature

Lima

Verdeal

Farias

2005

Arq Bras Endocrinol Metab

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RESUMOOsteonecrose em Pacientes Com Síndrome de Imunodeficiência Humana Adquirida (SIDA): Relato de Dois Casos e Revisão da Literatura. Um aumento na incidência de anormalidades no metabolismo ósseo-mineral (osteopenia/osteoporose) tem sido observado em pacientes com síndrome de imunodeficiência humana adquirida (SIDA). Relatamos dois casos de osteonecrose em pacientes com SIDA. Ambos os pacientes estavam recebendo terapia anti-retroviral de alta potência (HAART) e apresentavam um ou mais fatores de risco conhecidos para osteonecrose. Nós revisamos a literatura e discutimos a patogênese, diagnóstico, prevenção e tratamento desta patologia em pacientes com SIDA. ABSTRACTAn increase in the incidence of abnormalities on bone and mineral metabolism (osteopenia/osteoporosis) and the development of osteonecrosis has been observed in patients with acquired immunodeficiency syndrome (AIDS). Two cases of osteonecrosis in patients with AIDS are reported. Both patients were receiving highly active antiretroviral therapy (HAART) and presented with one or more known risk factors for osteonecrosis. We review the literature and discuss the pathogenesis, diagnosis, prevention and treatment of this entity in patients with AIDS.

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Avascular necrosis in HIV infection

Cited by 25 publications

References 6 publications

Osteonecrosis in Patients Infected with Human Immunodeficiency Virus: A Case‐Control Study

Osteonecrosis in Patients Infected with Human Immunodeficiency Virus: A Case‐Control Study

Avascular Necrosis of Bone in Patients with Human Immunodeficiency Virus Infection: Report of 6 Cases and Review of the Literature

Osteonecrosis in patients with acquired immunodeficiency syndrome (AIDS): report of two cases and review of the literature

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