Osteonecrosis in Patients Infected With HIV

Gutiérrez, Félix; Padilla, Sergio; Masiá, Mar; Flores, Juan; Boix, Vicente; Merino, Esperanza; Galindo, Jaime; Ortega, Enrique; López‐Aldeguer, José; Galera, Carlos

doi:10.1097/01.qai.0000225012.53568.20

Cited by 50 publications

(18 citation statements)

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“…Studies have suggested that osteonecrosis can occur at any level of immunosuppression. [ 23 ] In our study, 71% (20/28) of the HIV-positive patients had a viral RNA level <20 copies/ml. The mean HIV RNA level was 2356 copies/ml.…”

Section: Discussionmentioning

confidence: 53%

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Early Outcomes of Primary Total Hip Arthroplasty for Osteonecrosis of the Femoral Head in Patients with Human Immunodeficiency Virus in China

Zhao

Zhang

et al. 2015

Chinese Medical Journal

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Background:Studies have reported that patients with human immunodeficiency virus (HIV) have a high incidence of osteonecrosis of the femoral head (ONFH). Total hip arthroplasty (THA) is an effective management of ONFH. However, little data exist regarding the use of THA for the HIV patients with ONFH in China. This study reviewed the outcomes of HIV-positive patients who underwent THA for ONFH, compared with HIV-negative individuals.Methods:The patients who underwent THA for ONFH from September 2012 to September 2014 in Beijing Ditan Hospital, Capital Medical University were retrospectively studied. Twenty-eight HIV-positive patients and 35 HIV-negative patients underwent 48 THAs and 45 THAs with cementless components, respectively. Medical records and follow-up data were reviewed. Harris Hip Score (HHS) was applied to evaluate the pain and function of the hips before and after THA. Complications such as wound healing, surgical site infection, deep venous thrombosis, pulmonary embolism, sepsis, mortality, and complications from the prosthesis were reviewed. The operation time, blood loss, and hospital stay were compared between the two groups.Results:The mean follow-up period was 19.5 ± 5.8 months (ranging from 6 to 30 months). The mean age of the HIV-positive patients with osteonecrosis at the time of surgery was 35 years old, which was significantly lower than that of the HIV-negative group (42 years old) (P < 0.05). The HIV-positive patients underwent surgery a mean of 2.5 years after their original symptoms, which was significantly shorter than the HIV-negatives’ (mean 4 years) (P < 0.05). Among HIV-positive patients, the prevalence of being male and rate of bilateral procedures were significantly higher than those in the HIV-negative group (P < 0.05). The operation time in HIV-positive patients was significantly longer than that in HIV-negative patients (P < 0.05). There were no significant differences in blood loss or hospital stay between the two groups (P > 0.05). The HHSs of two groups significantly improved after THAs (P < 0.05), without significant difference between two groups. No wound complication, sepsis, mortality, prosthesis complication, and occupational exposure occurred, except for two cases of heterotopic ossification and one case of humeral head necrosis.Conclusions:ONFH is more likely to occur bilaterally in younger HIV-positive males. The development of osteonecrosis seems faster in HIV-positive patients than in HIV-negative patients. This should be cautionary for asymptomatic HIV-positive patients with low viral RNA level and in the primary HIV stage. Despite longer operation times in the HIV-positive patients than in the HIV-negative patients, THA is still a safe and efficient approach to treat ONFH in HIV-positive patients. The incidence of complications is much lower than previously reported. However, the long-term follow-up is needed.

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Section: Discussionmentioning

confidence: 53%

“…Gutiérrez et al . [ 23 ] alluded to an association with HAART, and more specifically protease inhibitors. They suggested the mechanism of protease inhibitors inducing ONFH may be hyperlipidemia.…”

Section: Discussionmentioning

confidence: 99%

Early Outcomes of Primary Total Hip Arthroplasty for Osteonecrosis of the Femoral Head in Patients with Human Immunodeficiency Virus in China

Zhao

Zhang

et al. 2015

Chinese Medical Journal

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“…Ries et al6) suggested that HIV infection itself is a major risk factor for osteonecrosis in their study involving 38 patients with atraumatic osteonecrosis of the femoral head. Another report7) also showed that the outcome of osteonecrosis in HIV-infected patients was affected by the occurrence site, gender and CD 4+ T cell count.…”

Section: Discussionmentioning

confidence: 96%

Operations about Hip in Human Immunodeficiency Virus-Positive Patients

et al. 2010

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BackgroundThe number of human immunodeficiency virus (HIV)-infected patients is increasing constantly, and it is well known that there is a significantly high prevalence of osteonecrosis of the femoral head in HIV-infected patients. Therefore, it is important to develop methods that can ensure the safety of both the patients and medical personnel who participate in surgery on HIV-infected patients. Recently, the authors performed 8 procedures on 5 HIV-infected patients. This paper reports our experience.MethodsThis study examined the medical records and radiological studies of 5 HIV-infected patients who had undergone surgery around the hip joint from January, 2005 to September, 2007. During the procedures, their mean age was 38.6 years (range, 23 to 53 years) and all were male. Four of them were under an anti-retroviral therapy program. The reasons for the operations were nonunion of the femoral shaft after trauma in two patients and osteonecrosis of both femoral heads in three. One autologous bone grafting, one screw fixation with autologous bone grafting, five total hip replacement arthroplasties, and one multiple drilling were performed. All procedures were carried out according to the guidelines of HIV infection control made by the Korea Centers for Disease Control and Prevention. The mean follow-up period was 16.6 months (range, 4 to 37 months).ResultsThe preoperative CD4 count was 130 in one patient, and 200 to 499 in the other 4. The viral loads were 15100 and 420 in two patients, and negative in the other 3. Bony union was achieved in those who had undergone autologous bone grafting. There were significant improvements in both the Harris Hip Score and functional state in those who had total hip replacement arthroplasty. There were no immediate postoperative complications, such as infection. During the follow-up period, one patient died from esophageal variceal bleeding. However, no surgery-related complications were observed in the other 4 patients.ConclusionsThere were no significant complications in HIV-infected patients after the operations around the hip joint when their preoperative immunity was optimal. In addition, the safety of medical personnel can be assured when the operation is performed in line with the guidelines of HIV infection control.

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“…The exact etiology of RDC is unknown; however, a number of proposed etiological theories have been published. Several authors have alluded to an association between ARV drugs–particularly protease inhibitors–and the onset of RDC 2) . Additional proposed factors associated with RDC include rheumatoid arthritis, deposition of hydroxyapatite or calcium phosphate crystals, and the use of anti-inflammatory drugs (e.g., indomethacin) 8) .…”

Section: Discussionmentioning

confidence: 99%

“…Whilst degenerative arthritis may be relatively rare in patients with HIV (who are predominantly of a younger age group), osteonecrosis, inflammatory and post-traumatic problems are seen on a regular basis in areas of high HIV seroprevalence. Whether osteonecrosis is an HIV-related complication, an adverse effect of antiretroviral (ARV) therapy or is caused by another HIV-associated condition remains unclear 2) . The reported estimated incidence of osteonecrosis of femoral head (ONFH) in patients with HIV ranges from 0.45% to 1.33% 3) , which is greater than in the general population.…”

mentioning

confidence: 99%

Sequential Bilateral Rapid Destructive Inflammatory Coxarthrosis in a Patient with Human Immunodeficiency Virus

Kim

Lee

2018

Hip & Pelvis

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The diagnostic criteria for sequential rapidly destructive coxarthrosis remain unclear and this condition is rarely reported in patients with human immunodeficiency virus (HIV). Here, we report a case of an HIV-infected 73-year old female who experienced hip joint destruction. The patient was diagnosed with HIV in 2012 (at age 68 years) and began continuous treatment with nucleoside reverse transcriptase and protease inhibitors.Twenty-nine months after her HIV diagnosis, the patient experienced osteonecrosis of the right hip and underwent a total hip arthroplasty (THA). Twelve months post right-hip THA, X-ray results showed good outcomes. Eight months later (20 months post THA), however, osteolysis of the left femoral head was detected upon radiological exam and THA of the left hip was performed; chronic inflammation and fibrosis were identified in the resultant biopsy. Favorable results were obtained at 3 months after the second surgery.

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Osteonecrosis in Patients Infected With HIV

Abstract: HIV-related osteonecrosis is associated with significant disability over time. Location of bone necrosis, sex, and CD4 cell count may influence the outcome. The risk for recurrences for patients who have experienced 1 episode is low.

Cited by 50 publications

References 19 publications

Early Outcomes of Primary Total Hip Arthroplasty for Osteonecrosis of the Femoral Head in Patients with Human Immunodeficiency Virus in China

Early Outcomes of Primary Total Hip Arthroplasty for Osteonecrosis of the Femoral Head in Patients with Human Immunodeficiency Virus in China

Operations about Hip in Human Immunodeficiency Virus-Positive Patients

Sequential Bilateral Rapid Destructive Inflammatory Coxarthrosis in a Patient with Human Immunodeficiency Virus

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