Avascular necrosis in HIV-infected patients receiving antiretroviral treatment: Study of seven cases

Abstract

Purpose: We analyzed clinical, radiological, scintigraphical, epidemiological, and immunological data in a group of HIV-infected patients with osteonecrosis. Method: The first case was diagnosed in June 1997, and 6 more were identified thereafter among 1,650 attended patients (0.36%). Mean age was 37.6 years (33-46), and all were men. Mean CD4+ lymphocyte count was 501 cells/μL (98-1156), viral load was undetectable (<50 copies/mL) in 5 patients, and only 2 had AIDS diagnosis. Two patients were alcohol abusers, 1 received corticosteroids, and 3 had hypertrigliceridemia. One patient was treated with d4T plus 3TC, and the remaining received HAART. In 2 patients, lipodystrophy was simultaneously diagnosed. Results: Mean time between first dose of antiretroviral drugs and onset of symptoms was 12 months (2-24). All patients developed pain and functional impotence of the affected joints, and the diagnosis was confirmed by imaging techniques. Distribution of the affected sites was as follows: both hips in 5 cases, femoral external condyle in 1, and multiple joints in 1. In 4 cases, the protease inhibitor was interrupted; there was clinical improvement in 2 of these cases. The unfavorable outcome of the remaining cases required surgical intervention. Conclusion: Metabolic and bone diseases should be considered a complication of HIV infection that is of growing importance.