Avascular necrosis in HIV patients: a case–control study

Whitlock, Gary; Herbert, Sophie; Copas, Andrew; Gilson, Richard; Ainsworth, JG

doi:10.1177/0956462413482814

Cited by 9 publications

(9 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This hypothesis was supported by a univariable association of AVN with a CD4 nadir >200 cells/µL and corticosteroid use >3 months. Prolonged corticosteroid treatment is more often used in late presenters (eg, as adjunctive treatment to opportunistic infections) or subsequent to ART start (eg, management of immune reconstitution inflammatory syndrome) [5, 6, 10, 12, 20, 21]. In contrast to other studies, we did not observe an association with the use of testosterone or megestrol acetate.…”

Section: Discussioncontrasting

confidence: 99%

“…In conclusion, we confirm previously recorded AVN risk factors such as heterosexual HIV acquisition, moderate/severe alcohol consumption [10, 21], hyperlipidemia, and corticosteroid use >3 months (trend) [5, 8, 10, 12, 21]. Our observation that TDF contributes to AVN is potentially worrisome and needs to be confirmed in other patient populations.…”

Section: Discussionsupporting

confidence: 87%

“…Along with other established risk factors, ART and especially protease inhibitors (PIs) have been implicated as risk factors for AVN, although by unknown mechanisms. Due to the rarity of AVN, no conclusive link has emerged between HIV, ART, and AVN [6, 8–10, 12]. We aimed to study the association of different ART classes (PIs, non-nucleoside reverse transcriptase inhibitors [NNRTI], nucleoside reverse transcriptase inhibitor [NRTI]) and individual ART agents with the occurrence of AVN among Swiss HIV Cohort Study participants (SHCS).…”

mentioning

confidence: 99%

See 2 more Smart Citations

Associations Between Antiretroviral Treatment and Avascular Bone Necrosis: The Swiss HIV Cohort Study

Bayard

Ledergerber

Flepp

et al. 2017

Open Forum Infectious Diseases

View full text Add to dashboard Cite

BackgroundHIV-infected individuals have an increased risk of avascular bone necrosis (AVN). Antiretroviral therapy (ART) and particularly protease inhibitors (PI) have been implicated as a risk factor. We aimed to study the associations of ART with the occurrence of AVN among Swiss HIV Cohort Study participants (SHCS).MethodsWe used incidence density sampling to perform a case control study within the Swiss HIV Cohort Study (SHCS) comparing prospectively collected AVN cases and controls by conditional logistic regression analysis. To evaluate the effect of ART, multivariable models were adjusted for HIV transmission risk group, age, alcohol consumption, use of corticosteroids, CD4 nadir, maximum viral load, and pancreatitis.ResultsWe compared 74 AVN cases and 145 controls. Associations with AVN were shown for heterosexual HIV acquisition (odds ratio [OR], 3.4; 95% confidence interval [CI], 1.1–10), alcohol consumption (OR, 2.7; 95% CI, 1.3–5.7), and hyperlipidemia (OR, 3.6; 95% CI, 1.4–9.6). After adding ART substances to the multivariable base model, there was evidence of an association for treatment with tenofovir (TDF) >1 year (OR, 4.4; 95% CI, 1.4–14) with AVN. Neither exposure to specific frequently prescribed ART combinations or ART drug classes nor cumulative ART exposure showed any associations with AVN.ConclusionsIn the HIV-infected population, a combination of risk factors such as heterosexual HIV acquisition, moderate to severe alcohol intake, and hyperlipidemia seem to contribute to AVN. ART does not seem to be a relevant risk factor for AVN. The association of prolonged TDF exposure with AVN needs to be confirmed.

show abstract

Section: Discussioncontrasting

confidence: 99%

Section: Discussionsupporting

confidence: 87%

mentioning

confidence: 99%

See 1 more Smart Citation

Associations Between Antiretroviral Treatment and Avascular Bone Necrosis: The Swiss HIV Cohort Study

Bayard

Ledergerber

Flepp

et al. 2017

Open Forum Infectious Diseases

View full text Add to dashboard Cite

show abstract

“…Many studies [29][30][31] have shown an association of ON in HIVpositive individuals undergoing antiretroviral therapy. It is unknown whether or not the association is due to protease inhibitors alone or is multifactorial in combination with other risk factors such as the HIV infection itself, a history of systemic corticosteroid use, or hyperlipidemia [32][33][34][35].…”

Section: Othersmentioning

confidence: 99%

Osteonecrosis of the femoral head: diagnosis and classification systems

Choi

Steinberg

Cheng

2015

Curr Rev Musculoskelet Med

103

View full text Add to dashboard Cite

Osteonecrosis of femoral head is a rare but disabling condition that usually results in progressive femoral head collapse and secondary arthritis necessitating total hip arthroplasty if not treated appropriately in early stages. However, early diagnosis is challenging as the onset of disease is insidious and the symptoms and signs are usually minimal and nonspecific until it becomes advanced. Of several diagnostic modalities, magnetic resonance imaging (MRI) is considered the imaging method of choice with the highest sensitivity and specificity, while detection of potential risk factors is very important as well. Many investigators have developed several different classification systems; however, there still is controversy regarding the optimal classification system. Diagnostic methods and the evolution of different classification systems will be reviewed in this paper.

show abstract

“…Unlike the West, where they appear as frequently associated with HIV and its treatment [22][23][24][25][26], no case of connectivity and vasculitis was found in our study.The rarity of these affections in the black race would be the main reason. The osteonecrosis are therefore now associated with HIV and/or with its treatment [9,[27][28][29] and they tend to be bilateral in our study. Tendinopathies and carpal tunnel syndrome are also common during HIV infection [10][11][12]30].…”

Section: Discussionmentioning

confidence: 84%