Risk factors for osteonecrosis in HIV-infected patients: impact of treatment with combination antiretroviral therapy

Abstract

Osteonecrosis appears to be a complication of both HIV infection and cART.

Rheumatic manifestations of human immunodeficiency virus infection

“…Hyperuricemia and gout have been associated with retronavir [66]. Recently, osteonecrosis has been shown to associate with duration of antiretroviral therapy [44 ]. The postulated mechanisms for osteonecrosis associated with antiretroviral therapy include dyslipidemia with abnormal fat distribution, increased production of antiprotein S, or antiphospholipid antibodies, due to enhanced humoral immunity [41 ,67].…”

“…It has been attributed to the presence of antiphospholipid antibodies, low CD4þ T-cell counts, and use of high-dose corticosteroids and antiretroviral therapy or their metabolic complications. [42,43,44 ].…”

The Incidence and Natural History of Osteonecrosis in HIV-Infected Adults

“…However, on the basis of current data, it is difficult to conclude that protease inhibitors or antiretroviral combinations are independently associated with the development of osteonecrosis [5,6,9,12,19,33]. It is important to note, however, that a number of risk factors for the development of osteonecrosis are associated with HIV infection, management of HIV-related complications, or antiretroviral therapy, including pancreatitis, hyperlipidemia, osteopenia/osteoporosis, and use of corticosteroids.…”

Osteonecrosis Related to Intraosseous Anesthesia: Report of a Case

“…Osteonecrosis, also termed avascular necrosis, was first reported in the hip of a HIV-infected patient in 1990 (14). Since then, numerous case reports of osteopenia, osteoporosis, and osteonecrosis have been reported, and the prevalence of these disorders may be increasing (15)(16)(17)(18). Estimates of the prevalence of osteonecrosis in HIV-infected patients vary and may be influenced by ART (13, 16, 19 -21).…”