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

Brown, Patricia D.; Crane, Lawrence R.

doi:10.1086/319745

Cited by 78 publications

(46 citation statements)

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“…12,13,51 However, several case-control studies have not found an association with antiret- roviral therapy; the most common risk factor has been previous treatment with systemic corticosteroids. 11,14,15,21 Similar to the adult studies, antiretroviral therapy was not an independent predictor of osteonecrosis in our study; the majority of cases and controls had been treated with antiretrovirals before the index case's LCPD diagnosis and 4 of the cases were diagnosed before the availability of PIs. Also similar to data in infected adults, 21,52 osteonecrosis was not associated with CD4 lymphocyte number, occurring in children with normal as well as low CD4 cell percentage.…”

Section: Discussionsupporting

confidence: 83%

“…Bilateral disease was observed in 1 child; an increased frequency of multisite osteonecrosis has been described in HIVinfected adults. 11 Half of the HIV-infected children with LCPD were below the third percentile height at the time of diagnosis. Abnormal growth, as demonstrated by low birth weight and delayed bone age, is a reported risk factor for LCPD in the general pediatric population.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8][9] In one study, 4.4% of 339 asymptomatic HIV-infected adults were found to have evidence of osteonecrosis by magnetic resonance imaging, 10 and in another study, the incidence of osteonecrosis in HIV-infected adults was 45 times greater than would be expected in the general population. 11 Recent reports have suggested that the incidence of osteonecrosis among HIV-infected adults may be increasing. 10,[12][13][14][15] In a report from the Johns Hopkins HIV Clinic Cohort, the incidence of osteonecrosis in HIV-infected adults from 1995 to 2000 increased from 0 to 4.8 per 1000 person-years.…”

mentioning

confidence: 99%

“…10,[12][13][14][15] In a report from the Johns Hopkins HIV Clinic Cohort, the incidence of osteonecrosis in HIV-infected adults from 1995 to 2000 increased from 0 to 4.8 per 1000 person-years. 14 The cause of osteonecrosis in HIV-infected persons is unknown, but it is thought to be possibly related to HIV infection itself 5 ; cytokine activation induced by HIV 16 ; or therapies for HIV or HIV-associated conditions, including treatment with antiretroviral drugs, 12,13,17,18 systemic corticosteroids, 14,19,20 lipidlowering agents, 4,8,11,21 and/or testosterone and anabolic steroids. 10,22 There has been 1 report of osteonecrosis among HIV-infected children.…”

mentioning

confidence: 99%

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Osteonecrosis of the Hip (Legg-Calvé-Perthes Disease) in Human Immunodeficiency Virus-Infected Children

et al. 2002

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ABSTRACT. Objective. Osteonecrosis of the hip has been reported in human immunodeficiency virus (HIV)-infected adults; whether this is related to HIV infection or its treatment is unknown. There has been 1 report of osteonecrosis among HIV-infected children. Specifically, avascular necrosis of the hip consistent with Legg-Calvé-Perthes disease (LCPD) was reported in 3 HIV-infected children with AIDS from Spain in 1992. We evaluated the prevalence and incidence of LCPD, the pediatric equivalent of adult osteonecrosis of the hip, in HIV-infected children participating in a prospective cohort study of long-term outcomes in HIV-infected and HIV-exposed children-Pediatric AIDS Clinical Trials Group (PACTG) protocol 219.Methods. PACTG 219 enrolled 2014 HIV-infected and 849 HIV-exposed, uninfected children between April 1993 and September 2000. Children had periodic examinations with collection of clinical and laboratory data. The database was reviewed for reports of LCPD and other bone disorders. A prevalent case was defined as LCPD diagnosis preceding PACTG 219 enrollment and an incident case had to have occurred between enrollment and September 2000. A case-control study (matching on age, gender, and race/ethnicity, which are known to be associated with risk of LCPD and HIV infection status) was performed to investigate factors possibly associated with LCPD.Results. Six cases of LCPD (4 prevalent cases reported at study entry; 2 diagnosed during 5837 person-years of follow-up) were observed; LCPD was seen only in children with perinatal HIV infection. LCPD prevalence was 199 per 100 000 compared with an estimated general pediatric population prevalence of 23 per 100 000. Based on age-adjusted general population rates, the expected number of prevalent cases at PACTG 219 study entry would have been 0.44; the age-adjusted LCPD prevalence rate ratio was 9.0 (95% confidence interval [CI]: 8.3-9.7) for HIV-infected children compared with the general population. LCPD incidence was 34 per 100 000 person-years (95% CI: 0.42-124) compared with the estimated general population incidence of 6 per 100 000 person-years (95% CI: 5-7). Based on age-adjusted general population rates, the expected incidence of LCPD in PACTG 219 would have been 0.42; the age-adjusted relative risk of LCPD in HIV-infected PACTG 219 children was 4.8 (95% CI: 0.56 -10.4). No cases were observed in uninfected children during 1919 person-years of follow-up on PACTG 219; the age-adjusted expected number of cases was 0.09. Median onset age was 7 years; 67% were of Hispanic or black race/ethnicity and 33% were female. Four of the 6 LCPD cases had received antiretroviral therapy before diagnosis; treatment was primarily with nucleoside reverse transcriptase inhibitors, and 2 had received protease inhibitors. Three of the LCPD cases had corticosteroid exposure before the diagnosis, but only 1 child had systemic exposure and the remaining 2 had topical exposure exclusively. In the case-control study, antiretroviral and corticosteroid therapy, CD4 cell percentage...

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Osteonecrosis of the Hip (Legg-Calvé-Perthes Disease) in Human Immunodeficiency Virus-Infected Children

et al. 2002

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“…In a small series taken from a single infectious disease practice in the United States, the incidence of avascular necrosis in an HIV-positive population has been reported to be 45 times that seen in the general population (Brown & Crane, 2001). This could play a role in initial bacterial colonization.…”

Section: Osteomyelitis Secondary To Host Diseasementioning

confidence: 99%